病院受診群からみたlinitis plastica型胃癌診断の現状―特に潜在的なlinitis plastica型胃癌について

Diagnosis of Linitis Plastica Type of Advanced Gastric Cancer in the Patient Group Who Visited to the Hospital

要旨　linitis plastica（以下，LP）型胃癌の診断の現状について病院の立場から，20年間に経験した胃癌2,235例を対象とし，その推移を調べた．その結果，近年，早期癌が50％を越え，手術可能進行癌と手術不能癌が減少していた．また，早期癌に占める胃体部領域におけるUl(－)の未分化型Ⅱcは1.9％から5.6％へと増加していた．一方，進行癌は減少が著しく，切除例でLP型胃癌は減少傾向にあるが，手術不能例ではBorrmann 4型（LP型胃癌を含む）に増加傾向がみられ，LP型胃癌は減少傾向があるとは言えなかった．潜在的なLP型胃癌は12例あり，その頻度は切除されたLP型胃癌の15.8％で，男女比は5：7，平均年齢43.8±8.2歳であった．術前診断は，ⅡcやⅡc＋Ⅲ型早期癌6例，Ⅱc進行癌3例，潜在的なLP型胃癌3例で，正診率は25％で，壁の伸展が良好なため粘膜病巣周囲への癌の拡がりを診断できなかった．5年生存は12例中5例（41.7％）で，n(－)群に多い傾向があったが，5年生存例の肉眼所見では原発巣周囲に形態的な特徴を認めなかった．

　For the purpose of analyzing the progress of gastric cancer, and diagnosing linitis plastica type of gastric cancer, 2,235 patients with gastric cancer encountered in our department in the past 20 years were investigated.

　Recently, the frequency of early cancer in gastric cancer has reached a rate of over 50%, and the frequency of undifferentiated type of Ⅱc without ulcer scar located in the upper part of the stomach (considered as the initial stage of linitis plastica) has also increased to 5.6% of early cancers. The incidence of resectable and non-resectable advanced cancers has tended to decrease, but the incidence of inoperable diffuse carcinomas (containing linitis plastica) is increasing. It is considered that a way to diagnose early-phase linitis plastica has not yet been established.

　Clinical aspects were discussed and analyzed in twelve patients with prestage of linitis plastica. This prestage linitis plastica is the so-called latent type in which diffuse cancerous invasion has not given rise to scirrhous contracture. Half of them were diagnosed before operation as having early cancer. The ratio of male to female was 5: 7, and the average age was 43.8 years. Five of 12 cases (41.7%) survived more than 5 years after the operation, but characteristic features suggesting that this early cancer had developed into linitis plastica were not able to be found.