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Stomach and Intestine(Tokyo) Volume 22, Issue 12 （December 1987）

胃と腸 22巻12号（1987年12月発行）

Japanese English

今月の主題早期食道癌の問題点

主題

表在性食道癌肉眼分類の新しい提案―病理の立場から New Macroscopic Classification of Superficial Esophageal Carcinoma from Pathologic Standpoint 井手博子 ¹ , 村田洋子 ¹ , 奥島憲彦 ¹ , 金原文英 ¹ , 羽生富士夫 ¹ , 山田明義 ² Hiroko Ide ¹ , Yoko Murata ¹ , Norihiko Okujima ¹ , Fujio Hanyu ¹ , Akiyoshi Yamada ² ¹東京女子医科大学消化器病センター外科 ²東京女子医科大学消化器放射線科 ¹Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College ²Department of Raidology, Institute of Gastroenterology, Tokyo Women's Medical College pp.1369-1376

発行日 1987年12月25日 Published Date 1987/12/25

DOI https://doi.org/10.11477/mf.1403112852

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要旨　第41回食道疾患研究会で示された新しい表在癌肉眼型分類（案）は表在隆起型（0-Ⅰ），表在平坦型（0-Ⅱ），表在陥凹型（0-Ⅲ）の3基本型から成る，今回各型の分類基準を探るため，癌腫の粘膜面からの凹凸の程度を自験例未治療切除表在癌120例について検討した．sm癌は2mm以上の隆起例は56/99（56％），1～0.5mm例33/99（34％），1mm以上の陥凹例10/99（10％），mm癌は1～0.5mmの凹凸例16/16（100％），ep癌は1～0.5mmの凹凸例5/5（100％）であった．0-Ⅱ型にep～mm癌は含まれると仮定し，その基準を癌巣の高低でみたところep～mm癌は1～0.5mm内の凹凸に含まれた．癌巣の高さが2mm以上を0-Ⅰ型，凹みが1mm以上を0-III型とすると，0-Ⅱ型の5生率は95.1％で，0-Ⅰ型55.3％，0-Ⅲ型43.0％に比し良好であった．この基準に従えば胃の早期癌に匹敵する肉眼型は0-Ⅱ型（粘膜癌とこれに類似するsm癌）がこれに相当するものと考えられた．

　New macroscopic classification of superficial esophageal carcinoma was advanced at the 41st Study Meeting on Esophageal Diseases this year by the Committee on Pathology. According to this classification, esophageal carcinomas are classified macroscopically into three basic types, i.e., superficial protruded (0-Ⅰ), superficial flat (0-Ⅱ) and superfical depressd (0-Ⅲ). 0-Ⅰ type is further subdivided into three subtypes, i.e., polypoid (Ip) including papillary, plateau shaped (Ⅰpl), predominantly subepithelial (Isep). 0-Ⅱ type is likewise subdivided into three types, i.e., slightly elevated (Ⅱa), flat (Ⅱb), and slightly depressed (Ⅱc). This proposed classification is to be applied to the clinical situation on a national scale for a year.

　In this paper we proposed our classification which modified 0-Ⅱ type described above so that carcinoma limited to the mucosa was predominantly included in 0-Ⅱ type. Based on our criteria, elevated lesions taller than 2 mm were classified into 0-Ⅰ type and small, 1 mm or so, elevated lesions into Ⅱa. With respect to excavated lesions, shallow erosive lesions of up to about 0.5 mm depth were included into Ⅱc and the lesions deeper than that into 0-Ⅲ type. Of the cases we experienced, according to our criteria, sm cancers were classified as follows: 0-I type (56/99; 56%), 0-Ⅱ type (33/99; 34%) and 0-Ⅲ type (10/99; 10%). All cases of mm cancer were classified into 0-Ⅱ type (16/16; 100%) as well as those of ep cancer into 0-Ⅱ type (5/5; 100%). Five-year survival rate for 0-Ⅱ type was 95.1% better than 55.3% for 0-I type and 43.0% for 0-Ⅲ type. According to our criteria, 0-Ⅱ type is considered corresponding to the macroscopic type early gastric cancer.