予後不良な食道T1a癌の画像診断・病理

Imaging and Pathology of Early Esophageal Squamous Cell Carcinoma with Poor Prognosis

要旨●1985年2月〜2021年10月までの間に，食道根治術を行った食道早期癌156例中リンパ節転移のあったのはすべてpT1a-MM癌であり（62例中6例，10%），すべて脈管侵襲陽性例であった．また，1989年12月〜2021年10月までの間に，当院にて内視鏡治療を行った食道表在癌1,171例のうち，2年以上の経過観察を終えたpT1a-MM癌150例157病変中，脈管侵襲陽性例の頻度は35病変（22%）であった．病理組織学的診断の結果を踏まえ根治手術を6例，放射線治療を2例，化学放射線治療を1例に行った．追加治療を行わなかった141例のうち4例（3%）にその後転移再発を認め，すべて原病死した．総合的にpT1a-MM癌206例中4例（2%）に原病死を認め，4例中2例は表層拡大型病変，1例は脈管侵襲陽性例，もう1例は脈管侵襲陰性かつ滴状浸潤陽性例であった．

　Of 156 cases of early esophageal cancer treated with radical esophagectomy between February 1985 and October 2021, 6 patients had lymph node metastasis, and all of them were pT1a-MM carcinoma and positive for vascular invasion（6 out of 62, 10%）.

　Of the 1,171 superficial esophageal cancer cases treated endoscopically at our hospital from December 1989 to October 2021, the frequency of vascular invasion-positive cases was 34, 35 lesions（22%）among 157 lesions in 150 pT1a-MM cancer cases with more than 2 years of follow-up.

　Based on the results of pathology, 6 patients underwent radical surgery, 2 patients underwent radiotherapy, and 1 patient underwent chemoradiotherapy, while out of 141 patients who did not receive additional treatment, 4 patients（3%）subsequently developed metastatic recurrence, and all died of primary disease.

　Overall, 4（2%）of 206 pT1a-MM cancer patients had primary death, 2 of 4 had superficial spreading lesions, 1 was positive for vascular invasion, and 1 was negative for vascular invasion and positive for drop-like infiltration.