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1 原著論文 - 細谷好則 1), 宇井崇 1), 倉科憲太郎 1), 春田英律 1), 斉藤心 1), 瑞木亨 1), 俵藤正信 1), 佐藤貴一 2), 山本徳博 2), 菅野健太郎 2), 長瀬通隆 3), 藤井博文 3), 柴山千秋 4), 中澤聖則 4), 三澤和秀 5), 和田政彦 5), 布宮伸 5), 平林由広 6), 西野宏 7), 宮崎邦夫 8), 去川俊二 8), 福嶋敬宜 9), 仁木利郎 9), 丹波嘉一郎 10), 佐田尚宏 1), 永井秀雄 1) 1), 安田是和 抄 録 - FP -FU mg/m Day -, CDDP: mg/m Day - Gy - FP -FU mg/m Day -, CDDP: mg/m Day FP Stage = n= StageI= n= StageII= n= StageIII= n= StageIV= n=. StageI StaegII I. はじめに Ⅱ. 対象と方法 Historical control Kaplan-Meier ICU - FP -FU mg/m Day -, CDDP: mg/m Day - FP -FU mg/m Day -, CDDP: mg/m Day -

2 Gy - FP -FU mg/m Day -, CDDP: mg/m Day FP -FU mg/m Day -, CDDP: mg/m Day T N M Ⅲ. 結果 - cc - cc Tis: / T a: / T b: / T : / T : / T : / f-stage Stage = StageI= StageII= StageIII= StageIV= - historical contorol StageO I III StageIV 表 1 自治医科大学附属病院食道癌手術患者背景 年 65 [35-84] Ce:6, Ut:39, Mt:174, Lt:88, Ae:10 Squamous cell carcinonma:286, Adenocarcinoma:14, Basaloid carcinoma:8, Carcinosarcoma:3, Malignant melanoma:3, Undifferentiated carcinoma:2, Adenosquamous cell carcinoma:1 T N M f-stage 0:I:II:III:IV Tis:15, T1a:14, T1b:78, T2:41, T3:148, T4:21 N0:137, N1:53, N2:67, N3:36, N4:24 M0:311, M1:6 0:25, I:54, II:94, III:106, IV:38 Chemoradiotherapy Chemotherapy None Chemortherapy 7

3 表 2 手術症例における深達度とリンパ節転移 n0 n1 n2 n3 n4 Tis n= /15 0% T1a n= * 0 4/14 29% * T1b n= /78 37% T2 n= /41 68% T3 n= /148 70% T4 n= /21 71% n= /317 57% * PR 1 図 1 進行度 (Stage) 別の生存曲線

4 表 3 自治医科大学附属病院食道癌手術のステージ別 3 年生存率 Stage 0 Stage I Stage II Stage III Stage IV Historical control n= n= n= n= n= n= n= n= n= n= n= n=38 表 4 自治医科大学附属病院食道癌手術の術後合併症 n= % 4% n=317 6% 4% 0.6% p <0.01 <0.01 <0.01 p-value: Chi-square test. f-stage. historical contorol Comprehensive Registry of Esophageal Cancer in Japan StageI II III Ⅳ. 考察 T a: m EMR,ESD T a: m. T b: sm. m CRT T a CRT / - / StageO StageO: StaegI:

5 表 5 自治医科大学附属病院と食道学会全国統計の手術 3 年生存と在院死亡 JMUH* CRECJ** CRECJ** CRECJ** n=317 n=1376 n=1482 n= % Stage n= n= n= n=117 Stage I 91.0 n= n= n= n=223 Stage II 79.2 n= n= n= n=441 Stage III 55.5 n= n= n= n=462 Stage IVa 11.2 n= n= n= n=142 Stage IVb 0 n=6 5.8 n= n= n=27 % % *JMUH: Jichi Medical University Hospital, **CRECJ: Comprehensive Registry of Esophageal Cancer in Japan CRECJ1995, 2 nd edition 6 CRECJ1998, 3 rd edition 7 CRECJ , ICU StageO StageIV StageO StageIV ICU JCOG FP JCOG FP FP FP

6 CRT CRT Hazard ratio HR :. HR:. CRT FP Sakayauchi FP FP Grade CRT JCOG CRT CRT+ trimodarity therapy Trimodarity therapy CRT vs. CRT 謝辞 ICU 文献 - - Hosoya Y, Shibusawa H, Nagai H et al: Preoperative Chemotherapy for Advanced Esophageal Cancer and Relation with Histological effect. Surgery Today : -,. Comprehensive Registry of Esophageal cancer in Japan,, nd Edition Comprehensive Registry of Esophageal cancer in Japan, rd Edition Comprehensive Registry of Esophageal Cancer in Japan, : Esophagus : -,. m sm -. - Osugi H, Takemura M, Higasino M et al: A comparison of video-assisted thoracoscopic oesophagectomy and radical lymphnode

7 dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg : -,. Isono K, Sato H, Nakayama K: Results of a nationwide study on the three-field lymph node dissection of esophageal cancer. Oncology : -,. Ando N, Ozawa S, Kitagawa Y et al: Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during consecutive years. Ann Surg : -,. Roux-Y -. Ando N, Iizuka T, Ide H et al: Surgery Plus Chemotherapy Compared With Surgery Alone for Localized Squamous Cell Carcinoma of the Thoracic Esophagus: A Japan Clinical Oncology Group Study- JCOG. J Clin Oncol : -,. Igaki H, Kato H, Ando N, et al: A randomized trial of postoperative adjuvant chemotherapy versus neoadjuvant chemotherapy for clinical stage II/III squamous cell carcinoma of esophagus. J Clin Oncol ASCO Meeting Proceeding Supplement,. Gebski V, Burmeister B, Smithers BM et al: Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol : -,. Hsu CH, Yeh KH, Lui LT et al: Concurrent chemoradiotherapy for locally advanced esophageal cancer: a pilot study by using daily low-dose cisplatin and continuous infusion of -fluorouracil. Anticancer Res : -,. Sakayauchi T, Nemoto K, Ishioka C, et al: Comparison of cisplatin and -fluorouracil chemotherapy protocols combined with concurrent radiotherapy for esophageal cancer. Jpn J Radiol : -,.. -.

8 Jichi Medical University Journal Results of surgical treatment for patients with thoracic esophageal carcinoma in Jichi Medical University Hospital from through Yoshinori Hosoya, Takashi Ui, Kentaro Kurashina, Hidenori Haruta, Shin Saito, Toru Zuiki, Masanobu Hyodo, Kiichi Sato, Norihiro Yamamoto, Kentaro Sugano, Michitaka Nagase, Hirohumi Hujii, Chiaki Shibayama, Masanori Nakazawa, Kazuhide Misawa, Masahiko Wada, Shin Nunomiya, Yoshihiro Hirabayashi, Hiroshi Nishino, Kunio Miyazaki, Shunji Sarukawa, Noriyoshi Fukushima, Toshiro Niki, Kiichiro Tanba, Naohiro Sata, Hideo Nagai, Yoshikazu Yasuda Abstract The results of surgical treatment for patients with thoracic esophageal carcinoma at Jichi Medical University Hospital from through were reviewed. Long-term outcome, prognosis, and postoperative complications were analyzed. Multi-modality treatment regimens, including surgery, varied over three time intervals for patients with advanced cancer: -, preoperative chemoradiotherapy: low-dose FU mg/m and cisplatin mg/m days - /three courses with concurrent radiotherapy Gy ; -, postoperative standard FP chemotherapy: FU mg/m day and cisplatin mg/m days - /two courses; and -, preoperative chemotherapy: standard FP/two courses. The -year cumulative survival rate was calculated using the Kaplan-Meier method for each stage: Stage, % n= ; Stage I, % n= ; Stage II, % n= ; Stage III, % n= ; and Stage IV, % n=. Postoperative complications included respiratory failure % and anastomotic leakage %. The hospital mortality rate was. %. The present multi-modality regimen, with surgery before or after chemotherapy, radiotherapy, or both, is inadequate to improve outcomes for patients with advanced esophageal carcinoma. However, there is a need for advanced staging to develop more effective multidisciplinary treatment regimens. Department of Surgery, Department of Gastoenterology, Department of Clinical Oncology, Department of Radiology, Division of Intensive Care, Department of Anesthesiology, Department of Otolaryngology-Head and Neck Surgery, Department of Plastic and Reconstructive Surgery, Division of Pathology, and Department of Palliative Medicine, Jichi Medical University

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