高齢早期胃癌患者に対する内視鏡治療の長期成績と適応

Long-term Outcomes and Indications for Endoscopic Treatment of Elderly Patients with Early Gastric Cancer

要旨●高齢早期胃癌患者に対する内視鏡治療の適応に関して，十分な知見は得られていない．今回，当院で内視鏡治療を施行した80歳以上の早期胃癌患者158例を対象に検討を行った．年齢中央値は82歳，治療5年後の予後補足率は84.8％であった．観察期間中に42例の死亡を認め，胃癌死は遠隔転移再発の4例のみであった．5年時点の全生存率は76.3％で，患者・病変因子において解析を行った結果，“PNI<48.1”が独立した生命予後不良因子として抽出された．適応に関して，現時点では明確な結論を導くことはできないが，今後，栄養状態を含めた患者因子，および早期胃癌の自然史を含む病変因子のさらなる検討を行い，総合的に判断できる指標の開発が重要であると考える．

　There is insufficient information on the indications for endoscopic treatment for elderly patients with early gastric cancer. In this study, we examined 158 patients aged >80 years who underwent endoscopic resection for early gastric cancer in our institute. The median age was 82 years, and the prognosis capture rate was 84.8% at 5 years after the procedure. There were 42 deaths, only 4 of which were caused by distant metastatic recurrence of gastric cancer. The 5-year OS（overall survival）rate was 76.3%. The analysis of OS, patient characteristics, and lesion factors demonstrated that a prognostic nutritional index <48.1 is an independent risk factor for poor prognosis of OS. The indications cannot be defined at this time. Future studies should include patient factors such as nutritional status and lesion factors, including the natural history of early gastric cancer, to develop an index against which the indications can be evaluated.