早期食道癌肉眼分類の問題点―臨床の立場から

Discussion on What to Do for Clinical Classification of Early Esophageal Carcinoma

要旨　X線的な発見能と描写能は，epとmmは難しいが，早期の基本型を示す．一方，smは，たやすく進行期の像を示す．前者を早期癌，後者を進行癌とする分類がよい，活用できる，というのが主張である．この主張を基盤にすると，胃と大腸の最近の再吟味と結着にも対応し，分類上の共通性も共有できると思われる．あっても，あまり使うことのない早期胃癌分類のⅢ型の呼称は，食道では消した．epとmmを基本型としたとき，smなのに，それに類似するもの，それらが混合していて分類しにくいものがある･これらの分類上の位置づけを，今から討議すればよいだろう．

　From the view-point of radiological diagnosis, discussion was made on clinical classification of early esophageal carcinoma. We consider now ep (epithelium) and mm (mucosa) as early carcinoma which means clinically curable one.

　According to Endo 1990, the 5-year-survival rate of esophageal carcinoma is 96.9% for ep, 91.9% for mm and 66.9% for sm. It must be understood that ep and mm are curable and thus considered as early carcinoma. On the other hand, sm is considered as already advanced one. These results support our clinical conclusion of radiological study on classification.

　Our conclusion based on 21 ep, 25 mm and 59 sm lesions is as follows.

　Lesions of ep and mm were designated as type Ⅱa and Ⅱc, respectively, and sm as type Ⅰ like, 1 and 2. We used the same terms as those in the classification of early and advanced carcinomas of the stomach.

　This enables us to use these terms for esophagus in the same way as for stomach carcinoma.

　In the near future, every effort should be made to establish more complete clinical classification of eshophageal carcinoma including early and advanced stages. For doing this further analyses are mandatory on the cases of sm which looks like early stage as well as rearrangement of such cases in the context of the clinical classificaton.