Treatment of superficial cancer of the esophagus: A summary of responses to a questionnaire on superficial cancer of the esophagus in Japan
Treatment of superficial cancer of the esophagus: A summary of responses to a questionnaire on superficial cancer of the esophagus in Japan
复制标题
DOI：
10.1016/s0039-6060(98)70165-5
复制
发表时间：
1998-04-01
期刊：
影响因子：
3.8
通讯作者：
Kakegawa, T
中科院分区：
文献类型：
--
作者：
Kodama, M;Kakegawa, T
背景：通过向日本食管疾病学会成员发放全国性调查问卷，基于来自143个机构的2418例患者，对浅表性食管癌的组织病理学特征和最佳治疗方式进行了重新评估。
方法：设计了一份调查问卷，针对1990年1月1日至1994年12月30日期间接受手术或内镜治疗的术前未经治疗的食管浅表癌患者。根据该学会制定的标准，将黏膜癌和黏膜下癌分为三个亚类。
结果：随着癌症浸润达到黏膜肌层，淋巴管侵犯阳性或淋巴结转移的发生率趋于显著增加。大多数具有O - I或O - III成分的病例为黏膜下癌。在接受调查的76%的机构中，内镜下黏膜切除术（EMR）的适应证仅限于黏膜1级和黏膜2级浅表癌。94%的患者对直径2cm或更大的肿瘤进行了分块切除。约6.8%的患者出现了EMR并发症，包括穿孔、狭窄和出血。几乎所有黏膜1级或黏膜2级癌症患者仍然存活。黏膜3级癌症与黏膜1级或黏膜2级癌症之间的预后没有显著差异，但黏膜下1级癌症的预后比黏膜癌差。
结论：对于局限于黏膜固有层的浅表性食管癌，局部切除癌灶被视为首选治疗方法。提倡进一步研究以确定针对黏膜3级或黏膜下1级癌症的治疗策略。
Background. Histopathologic characteristics and optimal treatment modality for superficial esophageal cancer were reevaluated on the basis of 2418 patients from 143 institutions through a nationwide questionnaire to the members of the Japanese Society for Esophageal Diseases.Methods A questionnaire was designed for patients with preoperatively untreated superficial cancer of the esophagus who had undergone either surgical or endoscopic treatment between January 1, 1990, and December 30, 1994. Mucosal cancer and submucosal cancer were divided into three subclasses according to the criteria formulated by the Society.Results. The incidence of positive lymphatic invasion or lymph node metastases tended to increase markedly as cancer infiltrates reached the lamina muscularis mucosa. The majority of the cases with O-I or O-III components were submucosal cancer. The indication of endoscopic mucosal resection (EMR) was limited to mucosal 1 and mucosal 2 superficial cancer in 76% of the institutions surveyed. Tumors measuring 2 cm or more in diameter were resected piecemeal in 94% of patients. complications of EMR, including perforation, stenosis, and hemorrhage, were observed in approximately 6.8% of patients. Almost all patients with mucosal 1 or mucosal 2 cancer are still alive. There was no significant difference in prognosis between mucosal 3 cancer and mucosal 1 or mucosal 2 cancer, but submucosal 1 cancer showed worse prognosis that mucosal cancer.Conclusions. Local resection of cancer lesions is regarded as the treatment of choice against the superficial esophageal cancers limited to the lamina propria mucosae. Further study is advocated to define the treatment strategy against mucosal 3 or submucosal 1 cancer.