高齢者早期胃癌ESDの予後と適応—Stage I胃癌の手術成績からみた高齢者に対するESD適応

Prognosis and Indications for Early Gastric Cancer ESD in the Elderly:Indications for ESD in the Elderly Patients with Stage I Gastric Cancer in Terms of Surgical Outcomes

要旨●日本胃癌学会の登録事業によるデータ集積から高齢Stage I胃癌患者の手術成績を解析した検討では，年齢階級が上がるにつれて5年全生存率は下がっていき，47.0〜93.1％の幅がある．一方，疾患特異的5年生存率は91.4〜98.2％であり，それほど下がらないことが示された．また，当院で高齢Stage I胃癌患者をE-PASSを用いて検討した結果，CRS高値群で有意に予後不良であった．また，多変量解析では，CRSは独立した予後因子であった．高齢早期胃癌患者では他病死を考慮に入れた場合，ある程度のリンパ節転移は予後に影響しないと考えられ，ESDによる局所治療拡大につながる．また，E-PASSは予後不良患者の選択に有用と考えられた．

　An analysis of the surgical results of elderly patients with Stage I gastric cancer based on data collected by the Japan Gastric Cancer Society registration project shows that the 5-year overall survival rate decreases with increasing age, ranging from 47.0%-93.1%. In contrast, the disease-specific 5-year survival rate was 91.4%-98.2% and did not differ significantly. In addition, an examination of elderly patients with Stage I gastric cancer using E-PASS（estimation of physiologic ability and surgical stress）at our hospital showed that the prognosis was significantly poorer in the high CRS（comprehensive risk score）group. In multivariate analysis, CRS was an independent prognostic factor.

　In elderly patients with gastric cancer, lymph node metastasis does not affect prognosis when mortality due to other diseases is taken into consideration, leading to the expansion of local treatment by endoscopic submucosal dissection. E-PASS was also considered useful for selecting patients with a poor prognosis.