Type III（sporadic type）胃カルチノイド腫瘍の多施設集計

A Questionnaire Survey Concerning Sporadic Type（Type III）of Gastric Carcinoid Tumors in Multi-institutions

要旨　sporadic typeの胃カルチノイド腫瘍の治療方針や臨床経過を明らかにする目的で，全国の10施設より集積した30例を対象に臨床病理学的検討を行った．大きさが5mm以下では転移例はなく，11mm以上の症例は10mm以下に比べて転移率が有意に高かった（p＝0.042）．組織型はNET G1とNET G2の間には転移率に差はなかったが，NECはNET G1＋NET G2に比べて転移率が有意に高かった（p＝0.018）．深達度はMとSMの間には転移率に差はなかったが，MPはM＋SMに比べて転移率が有意に高かった（p＝0.049）．脈管侵襲陽性例と陰性例の間には転移率に有意な差を認めなかった（p＝0.072）が，陽性例で転移率が高い傾向がみられた．sporadic typeの胃カルチノイド腫瘍に対する内視鏡治療の適応は，NET G1ないしNET G2で，かつ10mm以下の病変に限るべきであり，術前に超音波内視鏡で深達度を評価することが必須である．

　To elucidate therapeutic strategy and clinical courses of SGCTs（sporadic type of gastric carcinoid tumors）, 30cases with them were collected through a questionnaire survey of 10 institutions in Japan. SGCTs 5mm or less in size were not observed metastasis. The MR（metastatic rate）of SGCTs 11mm or larger in size were significantly higher compared with the MR of SGCTs 10mm or less（p＝0.042）. There was no significant difference between the MR of SGCTs with NET（neuroendocrine tumor）G1 and that with NET G2, however the MR of SGCTs with NEC（neuroendocrine carcinoma）were significantly higher than that of NET G1＋G2（p＝0.018）. The MR of SGCTs invaded to the proper muscularis were significantly higher compared with that of SGCTs located mucosa or submucosa（p＝0.049）. On the other hand, there was no significant difference between the MR of SGCT with and without invasion to vessels（p＝0.072）, but SGCT with invasion to vessels had the tendency of high MR.

　Indications of endoscopic treatment for SGCTs were considered to be as follows ; 1）10mm or less in size, and 2）NET G1 or NET G2 of histological type. Furthermore, we should undergo endoscopic ultrasonography to evaluate the depth of lesions before endoscopic removal.