胃癌ESD後の異時性多発胃癌例の臨床病理学的特徴と経過・予後

Clinicopathological Evaluation of Metachronous Gastric Cancers after ESD

要旨　胃癌ESDを受けた500例を経過観察（中央値5.2年）し，119例（24％）に同時性多発癌，61例（12％）に異時性多発癌が発見された．異時性例に原病死はないが，3例はSM2であった．また，EMR/ESDを受けた524例においてH. pylori感染，時代背景（1990年代vs. 2000年代），背景粘膜萎縮，同時多発，性別などの因子別に異時性多発癌累積発見率を検討した．同時多発例と男性から高率に異時多発癌が発見され，H. pylori陰性例からの発見は陽性例と同等であった．発癌を認めた胃炎粘膜からは，同時・異時合わせて30％以上の多発癌が発生することを念頭に置き，ESDの前後には慎重な内視鏡観察が必要である．

　A total of 500 patients who received initial endoscopic submucosal dissection（ESD）for early gastric cancer were evaluated retrospectively. Patients were followed-up by endoscopy for 1〜10years（median, 5.2years）. Synchronous multiple cancers were detected in 119 patients（24％）, and 61patients（12％）developed 76 metachronous multiple cancers. Of 76metachronous cancers, three（4％）were detected as being SM2 cancers. The Kaplan─Meier curve of the cumulative incidence of metachronous cancers was significantly increased in patients with synchronous cancers. No difference was observed between Helicobacter pylori-negative and H. pylori-positive patients. In endoscopic examination before and after ESD for patients with early gastric cancer, we should consider synchronous and/or metachronous cancers, as they may account for approximately 30％ of cases.