第46回食道色素研究会アンケート調査報告―転移のあったm3・sm1食道癌の特徴

Lymph Nodal Metastasis of m3, sm1 Esophageal Cancer

要旨　2001年11月に開催された第46回食道色素研究会にて“転移のあったm3，sm1食道癌”を主題とし，全国21施設にアンケート調査への御協力を頂いた．この結果，749例のm3，sm1癌が集計され，遠隔転移率は0.4％と少数で，いずれもly陽性であり，2例で静脈侵襲を認めた．リンパ節転移は深達度m3で9.3％，sm1で19.6％認め，0-Ⅰ，0-Ⅲ型，低分化型扁平上皮癌，ly，v陽性，Infβ，γ，術前深達度診断sm2，sm3群に多かった．EMR群に他病死を多く認めたが，原病死のみであれば食道切除，食道抜去，EMRの3群間に有意差を認めず，今回のretrospectiveな検討から転移のあるm3，sm1癌の特徴がある程度解明されたことから，今後はprospectiveな検討を開始するべきと思われた．

　Endoscopic mucosal resection (EMR) is the first choice of treatment for esophageal mucosal cancer, while esophagectomy is selected for submucosally invaded esophageal cancer. But, the incidence of lymph nodal metastasis of m3, sm1 esophageal cancer is between 7～20％ of such cancers.

　To know whether a m3, sm1 cancer has lymph nodal metastasis or not before esophagectomy, 749 m3, sm1 cancers were discussed at the 46th Congress of Japanese Research Society for Early Esophageal Cancer and Chromoendoscopy.

　Result: 　Incidence of lymph nodal metastasis of esophageal squamous cell carcinoma is 9.3％ in m3 and 19.6％ in sm1. Incidence of lymph nodal metastasis was high among the groups that included the 0-Ⅰ and 0-Ⅲ types, those 50 mm or more in size, those with poorly differential SCC, lymphatic permeation and venous permeation.

　Incidence of lymph nodal metastasis was 4.2％ in the group that has none of those risk factors. So, EMR can be selected for such patients.