胃と腸42巻9号

2007年08月発行

今月の主題 食道表在癌内視鏡切除後の長期成績 主題

大酒家における食道表在癌内視鏡切除後の2次癌―癌のない大酒家の長期経過との比較

著者： 横山顕¹ 大森泰² 横山徹爾³ 佐藤靖夫⁴ 川久保博文² 水上健¹

所属機関： ¹国立病院機構久里浜アルコール症センター ²川崎市立川崎病院外科 ³国立保健医療科学院技術評価部 ⁴川崎市立川崎病院耳鼻咽喉科

ページ範囲：P.1365 - P.1374

要旨　アルコール依存症者（ア症）の食道癌の内視鏡的粘膜切除（EMR）後の異時性発癌と，癌のなかったア症の発癌とを内視鏡経過観察で比較した．食道癌と口腔咽喉癌の6年発生率はそれぞれEMR後（n＝84）で56％と35％，食道異形成患者（n＝112）で31％と20％と高頻度だが，食道ヨード不染帯のなかった患者（n＝616）では4％と4％であった．ハザード比は不染帯のない患者を基準として，EMR後で23.8倍と14.2倍，食道異形成患者で11.2倍と6.55倍であった．アルデヒド脱水素酵素2（ALDH2）ヘテロ欠損者では，それぞれの6年発生率は，EMR後（n＝44）で70％と46％，癌がない患者（n＝72）で34％と30％といずれも高く，ALDH2正常者では，EMR後（n＝40）で30％と8％，癌がない患者（n＝484）で5％と5％であった．ハザード比はALDH2正常で癌がない患者を基準として，ALDH2欠損でEMR後の患者で32.6倍と21.8倍，ALDH2欠損で癌のない患者で11.7倍と11.6倍，ALDH2正常でEMR後の患者で8.12倍と7.36倍であった．ア症ではEMR後の異時性癌の頻度がALDH2欠損者で特に高いが，癌がない患者でも食道異形成やALDH2欠損があると非常に高い発癌リスクがみられ，これらの患者では厳重な長期間の内視鏡観察が必要である．

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