食道sm癌の臨床診断と予後―予後の良いもの悪いもの

A Clinical Study on Prognosis of Submucosal Esophageal Cancer

要旨　近年食道の表在型癌手術例が急増しているが，なおsm癌が圧倒的に多い．今回食道の早期癌としての条件は何か，sm癌につき予後の良いもの，悪いものの形態学的特色を食道表在癌159例の切除標本および治療経過から検討した．sm癌のsm層浸潤度と浸潤面積は予後と有意に相関した．わずかに浸潤をみるsm-Ⅰはほぼ粘膜癌の予後に匹敵，肉眼型は0-Ⅱb型，0-Ⅱc型に相当した．sm癌で予後の良いものの肉眼型はm癌類似の0-Ⅱb型，0-Ⅱc型と隆起型の単純型，深達度がsm-Ⅰとわずかなものと考えられた．予後の悪いsm癌の肉眼型は隆起型と陥凹型との混合型で0-Ⅰ型癌はIpl＋Ⅱc型，0-Ⅱa型癌はⅡa＋Ⅱc型であった．

　Nowadays, we have more operative cases of superficial esophageal cancer, though most of them are still sm-cancer which invade as far as the submucosal layer.

　To define the image of early esophageal cancer, we examined the morphological distinctions between cancers with good and poor prognosis in 159 resected superficial esophageal cancers.

　The depth of invasion and the area of submucosal spread of the submucosal cancer are significantly correlated with the prognosis. Hence, the prognosis of sm-Ⅰ cancer meaning slight invasion of the submucosal layer is the same as the prognosis of mucosal cancer, and the gross type of sm-Ⅰ cancer fits 0-Ⅱb, 0-Ⅱa.

　The gross type with good prognosis among smcancers are similar to mucosal cancer that shows as 0-Ⅱb, 0-Ⅱc, or as simple protruding type, with depth of invasion resembling sm-Ⅰ cancer.

　In contrast to these the gross types with poor prognosis are like the mixed type between elevated and depressed type. In 0-Ⅰ type cancer it shows Ipl+Ⅱc pattern, and in 0-Ⅱ type it shows Ⅱa+Ⅱc pattern.