Tsukuma H, Oshima A, Narahara H, Morii T
Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi, Osaka, Japan.
Gut. 2000 Nov;47(5):618-21. doi: 10.1136/gut.47.5.618.
Controversy has arisen on the natural history of early gastric cancer (EGC). While some emphasise the effectiveness of early detection in reducing mortality from gastric cancer, others insist that EGC is a pseudo-cancer. AIMS/PATIENTS/METHODS: To elucidate the natural history of EGC, a non-concurrent, long term, follow up study was conducted in 71 patients who were diagnosed endoscopically as having EGC, which was confirmed as cancer on biopsy, but in whom surgical resection was not conducted or delayed by more than six months.
The natural course of EGC was observed in 56 cases. Over a period of 6-137 months, 20 remained in the early stage while 36 progressed to the advanced stage. The proportion remaining in the early stage consistently decreased with time. Median duration of those who remained in the early stage was estimated as 44 months. The cumulative five year risk for progressing to the advanced stage was 63.0%. In 38 cases there was no evidence for undergoing surgical resection for gastric cancer. The cumulative five year corrected survival was estimated as 62.8% among those unresected. Hazard rate ratio for gastric cancer mortality was 0.65 (p=0.34) for screening detected versus non-screening detected. Hazard rate ratio for gastric cancer mortality was 0.51, significantly lower for patients whose operations were delayed compared with those unresected.
Although EGC showed a relatively long natural history in general, it progressed to the advanced stage with time and led to death from gastric cancer for the most part if left untreated.
早期胃癌（EGC）的自然史存在争议。一些人强调早期检测在降低胃癌死亡率方面的有效性，而另一些人则坚称EGC是一种假癌。目的/患者/方法：为阐明EGC的自然史，对71例经内镜诊断为EGC的患者进行了非同期长期随访研究，这些患者经活检确诊为癌症，但未进行手术切除或手术延迟超过6个月。
观察了56例EGC的自然病程。在6至137个月的时间里，20例仍处于早期，36例进展为晚期。处于早期的比例随时间持续下降。处于早期的患者的中位持续时间估计为44个月。进展为晚期的累积五年风险为63.0%。38例没有接受胃癌手术切除的证据。未切除患者的累积五年校正生存率估计为62.8%。筛查发现的患者与非筛查发现的患者相比，胃癌死亡率的风险率比为0.65（p = 0.34）。与未切除的患者相比，手术延迟的患者的胃癌死亡率的风险率比为0.51，显著更低。
尽管EGC总体上显示出相对较长的自然病程，但随着时间的推移会进展为晚期，如果不治疗，大部分会导致胃癌死亡。
