高齢者早期胃癌相対適応ESDの短期成績・長期成績

Short- and Long-term Outcomes of Endoscopic Submucosal Dissection for T1 Early Gastric Cancer Beyond the Indication in Elderly Patients（≥80 Years）

要旨●内視鏡的切除術相対適応のcT1早期胃癌に対しては外科手術が標準治療であるが，年齢や併存症などの理由により内視鏡的切除を選択することが許容されている．しかし，これらの治療成績に関する報告は少なく，治療選択やその効果に関するコンセンサスは十分得られていない．今回，筆者らは80歳以上の高齢者の相対適応cT1早期胃癌に対するESDと外科手術の治療成績について検討した．治療後の病理組織学的診断結果がeCure A，B，C-1に該当した病変は全体の12.2％にみられた．ESDでeCure C-2となり経過観察した症例では，全死亡例のうち胃癌死の割合は23.5％であった．一方，初回外科手術を行った症例でも全死亡例の20.5％に胃癌死を認めた．最終的にESDのみを施行した場合と外科手術を施行した場合を比較した検討では，両群の生存曲線に有意差はなく，生存に寄与する術前の予後予測因子として性別とPNIが抽出された．高齢者においては，根治度以外の要素が長期生存に影響するため，それらも加味して治療方針を判断する必要がある．

　Surgery is the standard of care for cT1 EGC（early gastric cancer）beyond the indications for ER（endoscopic resection）, but providers may opt for ER for reasons such as age and comorbidities. However, there are few reports on the outcomes of these treatments, and there is no consensus on treatment selection and effectiveness. In this study, we evaluated the outcomes of ESD（endoscopic submucosal dissection）and surgery for cT1 EGC beyond ER indication in elderly patients（≥80 years）. Twelve percent of the lesions were pathologically eCureA, B, and C-1. In patients who were followed up without surgery after eCureC-2 resection of ESD, the rate of deaths from gastric cancer was about 23.5% of all deaths.

　On the other hand, deaths from gastric cancer were also found in 20.5% of all deaths in patients who underwent surgery for initial treatment. In a case comparison of ESD alone and surgery, the survival curves of the two groups did not differ significantly, and gender and prognostic nutritional index were extracted as preoperative prognostic factors contributing to survival. In elderly patients, factors other than curability may affect long-term survival ; thus, these factors should be considered in determining the treatment plan.