早期胃癌症例に対して未治療経過観察を行った超高齢者の1例

An Elderly Patient with Early Gastric Cancer Who was Followed-up without Treatment

要旨●患者は，97歳の女性．上部消化管内視鏡検査（EGD）にて胃噴門直下小彎に約10mm大の0-I型早期胃癌を指摘された．生検病理組織学的診断では，胃型の低異型度分化型癌を疑う所見であった．認知症の既往がある超高齢者であることから未治療経過観察とされた．以後，不定期にEGDを施行し病変を経時的に観察した．発症後100か月の時点までは，内視鏡的に粘膜内癌の所見であった．107か月後にはSM浸潤癌の所見を認め，115か月後には進行癌のEGD所見を呈した．EGD発見時より123か月後に老衰のため死亡した．発見時より100か月の期間は粘膜内癌で経過したが，SM浸潤の所見を呈した後，比較的短期間のうちに進行癌の所見を呈するに至った．超高齢者早期胃癌症例に対して，治療を施行せず長期間，病変と患者の予後を含めた経過を観察し報告した．

　The patient was a 97-year-old woman whose upper gastrointestinal tract endoscopy revealed type 0-I early gastric cancer lesion, 〜10mm in diameter, on the lesser curvature below the cardia. Biopsy and pathology findings were suggestive of a low-grade differentiated carcinoma. Given that she was an elderly woman with a history of dementia, follow-up was performed without treatment. Upper gastrointestinal tract endoscopy was occasionally conducted to observe the lesion over time. This endoscopy revealed intramucosal carcinoma, SM invasive carcinoma, and advanced cancer at 100 months, 107 months, and 115 months, respectively, after the onset of gastric cancer. The patient died 123 months after the onset of cancer. The follow-up findings based on endoscopy were intramucosal carcinoma within 100 months after the detection of gastric cancer ; however, progression from SM invasive carcinoma to advanced cancer occurred over a relatively short period. Here, we reported the progression of the tumor and the prognosis of an elderly patient with early gastric cancer who was followed up without treatment for long.