食道胃接合部腺癌の臨床病理学的特徴

Clinicopathological Characteristics of Superficial Adenocarcinoma of the Esophagogastric Junction

要旨●食道胃接合部腺癌の臨床病理学的特徴について自験例を加えた論文レビューを行い，食道胃接合部腺癌に関連した諸問題について検討した．8論文と自験例より507例の表在食道胃接合部腺癌のデータを集計したところ，表在食道胃接合部腺癌は70歳前後の男性を中心に見られ，組織型は分化型腺癌が多く肉眼型では隆起型が多かった．また，本邦において食道胃接合部癌の定義は西分類が主に用いられており，EGJから上下2cmに腫瘍の中心を認める癌と定義されている．EGJの同定には短いBarrett食道の頻度が高い本邦では，内視鏡的に食道下部に観察される柵状血管がランドマークとして適しているであろう．本邦では欧米ほど症例数が多くないため共通の定義を用いてデータを解析し，治療適応条件などを決めていくことが必要であろう．

　We reviewed eight Japanese articles on superficial adenocarcinoma of the EGJ（esophagogastric junction）to assess the clinicopathological characteristics including the definition of EGJ, differences between the AJCC/UICC（American Joint Committee on Cancer/International Union against Cancer）TNM and Japanese classifications, chronological trends, and biological prognoses. From a total of 507 cases, the clinicopathological characteristics of a patient with superficial adenocarcinoma of EGJ were the following: 70-year-old male presenting with differentiated type adenocarcinoma with a high frequency of protruded or combined superficial and protruded-type morphologies. The most used classification system was Nishi's classification, which defines cancer at the EGJ as a tumor center located within 2cm proximal to and distal from the EGJ. Because of the high prevalence of ultra-short segment Barrett's esophagus in Japan, the lower esophageal palisade vessels observed are suitable for use as a landmark of EGJ.