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Stomach and Intestine(Tokyo) Volume 50, Issue 4 （April 2015）

胃と腸 50巻4号（2015年4月発行）

Japanese English

今月の主題早期大腸癌内視鏡治療後の中・長期経過

主題

発生部位からみた早期大腸癌内視鏡的治療後の中・長期経過─結腸vs．直腸 Long-term Outcomes after Endoscopic Resection in Submucosal Colorectal Cancer（Colon vs. Rectum）池松弘朗 ¹ , 依田雄介 ¹ , 松田尚久 ² , 山口裕一郎 ³ , 堀田欣一 ⁴ , 小林望 ⁵ , 藤井隆広 ⁶ , 大野康寛 ¹ , 坂本琢 ² , 中島健 ² , 鷹尾まど佳 ³ , 篠原知明 ⁴ , 藤盛孝博 ⁷ , 金子和弘 ¹ , 斎藤豊 ² Hiroaki Ikematsu ¹ , Yusuke Yoda ¹ , Takahisa Matsuda ² , Yuichiro Yamaguchi ³ , Kinichi Hotta ⁴ , Nozomu Kobayashi ⁵ , Takahiro Fujii ⁶ , Yasuhiro Oono ¹ , Taku Sakamoto ² , Takeshi Nakajima ² , Madoka Takao ³ , Tomoaki Shinohara ⁴ , Takahiro Fujimori ⁷ , Kazuhiro Kaneko ¹ , Yutaka Saito ² ¹国立がん研究センター東病院消化管内視鏡科 ²国立がん研究センター中央病院消化管内視鏡科 ³静岡県立静岡がんセンター内視鏡科 ⁴佐久総合病院胃腸科 ⁵栃木県立がんセンター画像診断部 ⁶藤井隆広クリニック ⁷神鋼病院病理診断センター ¹Department of Gastrointestinal Oncology & Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan ²Endoscopy Division, National Cancer Center Hospital, Tokyo ³Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan ⁴Department of Gastroenterology, Saku Central Hospital, Saku, Japan ⁵Department of Diagnostic Imaging, Tochigi Cancer Center, Tochigi, Japan ⁶Takahiro Fujii Clinic, Tokyo ⁷Diagnostic Pathology Center, Shinko Hospital, Kobe, Japan キーワード：大腸T1癌 , 長期予後 , 再発率 Keyword: 大腸T1癌 , 長期予後 , 再発率 pp.405-412

発行日 2015年4月25日 Published Date 2015/4/25

DOI https://doi.org/10.11477/mf.1403200206

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要旨●大腸pT1癌において内視鏡的治療のみで経過観察された中・長期成績の報告は少ない．内視鏡的治療が先行されたpT1癌の中・長期成績を検討したところ，大腸癌治療ガイドラインに反して，pT1b癌を内視鏡的切除のみで経過観察すると，追加外科切除群に比べ局所再発が多く，またほとんどが直腸癌であった．そこで，今回結腸・直腸癌別中・長期予後を多施設で検討した．その結果，pT1b癌を内視鏡的摘除のみで経過観察した群において，結腸癌と比較し直腸癌が有意に局所再発を多く認めた．またリスク因子での多変量解析（Cox回帰分析）において部位のみ有意差があった．以上より直腸pT1癌は，現ガイドラインに沿った追加手術の重要性が確認された．今後，拡大適応を議論するうえで部位は重要な因子になると考える．

　The possible enlargement of the indicated organ post-endoscopic therapy for colorectal submucosal cancers has been discussed recently. However, little is known about the long-term outcomes of patients with submucosal invasive colorectal cancer who undergo endoscopic resection. We performed a retrospective analysis of the long-term outcomes of patients treated for submucosal colon and rectal cancer. A total of 787 patients with submucosal colorectal cancers who underwent endoscopic or surgical resection at 6 institutions were enrolled in the study, with a median follow-up period of 60.5 months. Patients were classified into one of the 3 groups : low-risk patients undergoing only endoscopic resection（Group A）, high-risk patients undergoing only endoscopic resection（Group B）, and high-risk patients undergoing surgical resection that included lymph node dissection（Group C）. We assessed recurrence rates, 5-year disease-free survival, and 5-year overall survival. Cox regression analysis was used to compare recurrences. The rates of recurrence, disease-free survival, and overall survival in group A for submucosal colon and rectal cancer were 0% vs. 6.3%, 96% vs. 90%, and 96% vs. 89%, respectively. In group B for submucosal colon and rectal cancer, these values were 1.4% vs. 16.2%（p<.01）, 96% vs. 77%（p<.01）, and 98% vs. 96%, respectively. Tumor location was the only factor that contributed significantly to disease recurrence and death（hazard ratio, 6.73 ; p＝.045）. In group C for submucosal colon and rectal cancer, these values were 1.9% vs. 4.5%, 97% vs. 95%, and 99% vs. 97%, respectively. The risk of local recurrence was significantly higher in high-risk patients with submucosal rectal cancer than in those with submucosal colon cancer when treated with endoscopic resection.