早期胃癌ESD後の除菌患者における異時性多発胃癌発生関連因子の検討─特に喫煙について

Factors Associated with Metachronous Gastric Cancer in Patients Undergoing Endoscopic Submucosal Dissection of Early Gastric Cancer after Helicobacter pylori Eradication

要旨●胃癌の危険因子として，H. pyloriの他に喫煙などが報告されており，異時性多発胃癌に対しても喫煙の関与が報告されている．本検討では，早期胃癌内視鏡的粘膜下層剝離術（ESD）後のH. pylori除菌患者を対象とし，年齢，性別，BMI，現喫煙，現飲酒，内視鏡的萎縮について，異時性多発胃癌発生関連因子を検討した．その結果，“60歳以上”，“現喫煙”が独立危険因子であり，喫煙は総量依存性に関連していた．よって，上記リスク患者では，早期胃癌ESD後除菌してからも異時性多発胃癌検索のためのより慎重な内視鏡サーベイランスが必要と考えられた．

　Previous reports have indicated that cigarette smoking and Helicobacter pylori（H. pylori）infection are both risk factors for gastric cancer. In particular, we have reported that cigarette smoking is associated with the development of metachronous gastric cancers. In this study, we investigated the factors associated with the development of metachronous gastric cancer in patients who underwent endoscopic submucosal dissection for early gastric cancer after H. pylori eradication. The factors considered were age, gender, BMI, current cigarette smoking, current alcohol drinking, and gastric mucosal atrophy diagnosed by endoscopy. Multivariate analysis revealed that in addition to age ≧60 years, cigarette smoking remained an independent risk factor for the development of metachronous gastric cancer in a dose dependent manner. Thus, in patients who currently smoke and who are treated by endoscopic submucosal dissection, we recommend frequent endoscopic surveillance to check for the development of metachronous gastric cancers, even after H. pylori eradication.