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Stomach and Intestine(Tokyo) Volume 55, Issue 10 （September 2020）

胃と腸 55巻10号（2020年9月発行）

Japanese English

今月の主題食道SM扁平上皮癌治療の新展開

主題

食道SM2癌の内視鏡治療後の長期予後 Long-term Prognosis for Esophageal Squamous Cell Carcinoma T1bSM2 Treated with Endoscopic Submucosal Dissection 高橋亜紀子 ¹ , 小山恒男 ¹ Akiko Takahashi ¹ , Tsuneo Oyama ¹ ¹佐久医療センター内視鏡内科 ¹Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan キーワード：食道扁平上皮癌 , T1b-SM2 , ESD , 長期予後 Keyword: 食道扁平上皮癌 , T1b-SM2 , ESD , 長期予後 pp.1249-1256

発行日 2020年9月25日 Published Date 2020/9/25

DOI https://doi.org/10.11477/mf.1403202136

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要旨●2000年1月〜2017年4月までに当院でESDを施行した前治療のない食道扁平上皮癌（SCC）T1b-SM2，cN0で，3年以上予後を追跡し得た47例47病変を対象とし，T1b-SM2に対するESDの妥当性を検証した．全体では，再発率2.1%（1/47），原病死率2.1%（1/47），疾患特異的3年生存率で98%，5年で98%，全生存率は3年で89%，5年で75%であった．また，深部断端陽性例，局所再発例はなく，局所コントロール率は100%であった．対象を脈管侵襲陽性（ly陽性and/or v陽性）：high risk group，脈管侵襲陰性（ly陰性v陰性）：low risk groupに分けて検討すると，high risk group（15例）では，追加治療あり11例，なし4例で，平均年齢は79歳，69歳と有意差を認めた（p＝0.0182）．再発と原病死は1例のみ（同一症例）で，追加治療の有無による再発率，原病死率に差はなかった．追加治療あり，なし群の5年全生存率は72%，25%であった．他病死率は36.4%（4/11），75.0%（3/4）であった．追加治療なし群は高齢者が多く，他病死が多いため，5年生存率が低下したと考えられた．low risk group（32例）には原病死はなく，追加治療あり19例，なし13例で年齢，再発率，原病死率，他病死率に差はなかった．ESDのT1b-SM2癌に対する局所コントロール率は高く，特に他病死の多い高齢者においては，ESD単独治療も選択肢に挙がると考えられた．

　Forty-seven lesions in forty-seven patients with ESCC（esophageal squamous cell carcinoma）T1bSM2, cN0 who were treated with ESD（endoscopic submucosal dissection）in the period from January 2000 to April 2017 were investigated retrospectively. All the patients could be followed up for at least 3 y.

　The overall rates of recurrence and death associated with ESCC were 2%（1/47）and 2%（1/47）, respectively. The 3-year and 5-year cause-specific survival rates were 98% and 98%, respectively. The 3-year and 5-year overall survival rates were 89% and 75%, respectively. There was no vertical margin positive and local recurrence. The rate of local control was 100%.

　The enrolled patients were divided into the high-risk group（lymph duct involvement positive and/or vascular involvement positive）and low-risk group（lymph duct and vascular involvement negative）.

　The high-risk group（n＝15）had 11 patients who underwent AT（additional treatment）and 4 who did not undergo AT ; the average patient age in these two groups was significantly different（79 y vs. 69 y, respectively, p＝0.0182）. Only 1 patient（2%）had recurrence and died because of ESCC. There was no significant difference in the recurrence rate and death rate of SCC between patients with and without AT. The 5-year overall survival rates among patients who underwent AT and those who did not undergo AT were 72% and 25%, respectively. The mortality rate was 36%（4/11）and 75%（3/4）among those who did and did not undergo AT, respectively. The 5-year overall survival rate was low because the group that underwent AT had many elderly patients who had a high mortality rate.

　The low-risk group（n＝32）had 19 patients who underwent AT and 13 who did not underwent AT. There was no ESCC-related death. There was no significant difference in the age, recurrence rate, SCC-related death rate, and mortality rate between patients who did and did not undergo AT.

　The rate of local control for T1bSM2 treated with ESD was high. ESD alone is a good treatment option, especially in elderly patients with a high mortality rate.