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EndoTODAY ³»½Ã°æ ±³½Ç


[Á¶±âÀ§¾Ï ¸²ÇÁÀý ÀüÀÌ À§ÇèÀÎÀÚ] - End of document

1. Á¶±âÀ§¾Ï ¸²ÇÁÀý ÀüÀÌ À§ÇèÀÎÀÚ

Á¶±âÀ§¾Ï ¸²ÇÁÀý ÀüÀÌ À§ÇèÀÎÀÚ¿¡ ´ëÇÑ °¡Àå À¯¸íÇÑ ºÐ¼®Àº 2000³â Dr. GodotaÀÇ ¿¬±¸ÀÔ´Ï´Ù (Gotoda. Gastric Cancer 2010;3:219). Expanded indication¿¡ ´ëÇÑ Á¦¾ÈÀÌ Æ÷ÇԵǾî ÀÖ½À´Ï´Ù.

2009³â Hirasawa°¡ ºñ½ÁÇÑ ³í¹®À» ¹ßÇ¥ÇÏ¿´´Âµ¥ 2000³â GotodaÀÇ ¿¬±¸¿Í °ÅÀÇ ºñ½ÁÇÑ °á°úÀÔ´Ï´Ù (Hirasawa. Gastric Cancer. 2009). »ç½Ç µÎ ¿¬±¸°¡ °°Àº º´¿ø(µ¿°æ¾Ï¼¾ÅÍ¿Í µ¿°æ¾Ï¿¬±¸È¸º´¿ø)¿¡¼­ ÀÌ·ç¾îÁ³±â ¶§¹®¿¡ Hirasawa ¿¬±¸¿¡ Gotoda ¿¬±¸ ÀÚ·á°¡ Æ÷ÇÔµÈ °ÍÀº ¾Æ´Ñ°¡ Àǽɵ˴ϴÙ. Hirasawa´Â undifferentiated-type¸¸À» ´ë»óÀ¸·Î ÇÏ¿´°í ȯÀÚ ¼ýÀÚ°¡ ÈξÀ ¸¹¾Ò½À´Ï´Ù.

2008³â ³×´ú¶õµåÀÇ Kwee°¡ ¸ÞŸºÐ¼®À» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Kwee. Gastric Cancer. 2008). Èï¹Ì·Î¿î Á¡Àº Á¡¸·¾Ï¿¡¼­ ÀþÀº ³ªÀÌ (57¼¼ ÀÌÇÏ)¿Í Á¡¸·ÇϾϿ¡¼­ ¿©¼ºÀÌ À§ÇèÀÎÀÚ¿´´Ù´Â Á¡ÀÔ´Ï´Ù. ÀþÀº ¿©¼º¿¡¼­´Â Á¶½ÉÇØ¾ß ÇÔÀ» ½Ã»çÇÏ°í ÀÖ½À´Ï´Ù.

2018³â ÀϺ» °¡À̵å¶óÀο¡ ½Ç¸° µ¿°æ¾Ï¼¾ÅÍ ÀÚ·áÀÔ´Ï´Ù.


2. 1±â À§¾Ï Àç¹ßÀ§ÇèÀÎÀÚ

2016³â 1¿ùÈ£ Gastric CancerÁö¿¡ ¾Æ»êº´¿ø ¿Ü°ú¿¡¼­ 1±â À§¾Ï Àç¹ßÀ§ÇèÀÎÀÚ¸¦ ºÐ¼®ÇÑ °á°ú¸¦ º¸°íÇÏ¿´½À´Ï´Ù (Park JH. Gastric Cancer 2016). 6°³ÀÇ independent risk factor°¡ Á¦½ÃµÇ¾ú½À´Ï´Ù. ¸²ÇÁÀý ÀüÀ̺¸´Ù´Â lymphovascular invasionÀÌ ´õ Áß¿äÇÏ´Ù´Â ¸»Àϱî¿ä?


3. Á¡¸·¿¡ ±¹ÇÑµÈ signet ring cell carcinomaÀÇ ¸²ÇÁÀý ÀüÀÌ À§Çè

2016³â 1¿ù Ann Surg¿¡ Á¡¸·¿¡ ±¹ÇÑµÈ signet ring cell carcinomaÀÇ ¸²ÇÁÀý ÀüÀÌ À§Çè¿¡ ´ëÇÑ »ï¼º¼­¿ïº´¿øÀÇ ºÐ¼®ÀÌ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Pyo JH. Ann Surg 2016).

1,544¸íÀÇ È¯ÀÚ¸¦ ºÐ¼®ÇÏ¿´À» ¶§ ¸²ÇÁÀý ÀüÀÌ´Â 3.8%¿¡¼­ ¹ß°ßµÇ¾ú½À´Ï´Ù.

¼¼ °³ÀÇ À§ÇèÀÎÀÚ°¡ È®ÀεǾú½À´Ï´Ù (tumor size ¡Ã1.7 cm, tumors of elevated type, and lymphatic-vascular involvement). Non-elevated type¿¡ ºñÇÏ¿© elevated typeÀÌ ¹«·Á 5¹è À§ÇèÇß½À´Ï´Ù.

¼¼ À§ÇèÀÎÀÚ¸¦ ÀÌ¿ëÇÏ¿© risk scoring systemÀÌ ¸¸µé¾îÁ³½À´Ï´Ù.

À̸¦ Àû¿ëÇÏ¿´À» ¶§ÀÇ Á¡¼ö¿Í ¸²ÇÁÀý ÀüÀÌ°¡ linearÇÑ °ü°è°¡ ÀÖÀ½À» º¸¿©ÁÖ¾ú½À´Ï´Ù.

Ç¥Á¤ÀÇ ¼±»ý´Ô, ÀÌÇõ ¼±»ý´Ô. ÁÁÀº ¿¬±¸ ÃàÇÏÇÕ´Ï´Ù.


4. Two-dimensional tumor size is an acceptable measurement method for estimating the risk of LN metastasis (Kim TJ. Gastrointest Endosc 2016)

À§¾Ï Å©±â¸¦ 2Â÷¿øÀ¸·Î ÃøÁ¤ÇÏ¿´À» ¶§ ¸²ÇÁÀý ÀüÀÌ À§ÇèÀ» Æò°¡Çϴµ¥ µµ¿òÀÌ µÈ´Ù´Â °á·ÐÀÔ´Ï´Ù.


5. Nomogram

»ï¼º¼­¿ïº´¿ø¿¡¼­ Á¶±âÀ§¾Ï ¸²ÇÁÀý ÀüÀ̸¦ ¿¹ÃøÇÏ´Â nomogramÀ» °³¹ßÇÏ¿´½À´Ï´Ù (Endoscopy 2020).

NomogramÀ¸·Î ¿¹ÃøÇÑ °ª°ú ½ÇÁ¦ ¸²ÇÁÀý ÀüÀ̸¦ ºñ±³ÇÏ¿´À» ¶§ ¸Å¿ì ºñ½ÁÇÔÀ» ¾Ë ¼ö ÀÖ½À´Ï´Ù.

±Ý¹ø ³í¹®¿¡¼­´Â ½ÇÁ¦ ȯÀÚ¿¡¼­ÀÇ Àû¿ëÇÑ ¿¹¸¦ ¸î °³ Á¦½ÃÇÏ¿´½À´Ï´Ù. ÀÓ»ó¿¡¼­ ¸Å¿ì À¯¿ëÇÏ°Ô »ç¿ëÇÒ ¼ö ÀÖ´Â nomogramÀ̶ó´Â °ÍÀ» º¸¿©ÁÖ¾ú½À´Ï´Ù.

±è¼ö¹Ì, ÀÌÁØÈ£ ±³¼ö´Ô. °í»ý ¸¹À¸¼Ì½À´Ï´Ù.


[Cases]

[2016-5-16] À§ ÁÖº¯ ¸²ÇÁÀýÀº ºñƯÀÌÀûÀ¸·Î Ä¿Áø °æ¿ì°¡ ¸¹À¸¹Ç·Î CTÀÇ specificity°¡ ¿Ïº®ÇÏÁö´Â ¾Ê½À´Ï´Ù. ESD¸¦ °í·ÁÇß´õ¶óµµ CT¿¡¼­ r/o metastatic lymph node·Î ³ª¿À¸é ¼ö¼úÀ» ¼±ÅÃÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ¼ö¼ú ÈÄ ¸²ÇÁÀý ÀüÀÌ°¡ ¾ø´Ù°í ³ª¿À¸é ¾Æ½±Áö¸¸... ¾î¿ ¼ö ¾ø´Â ¼±ÅÃÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.

Stomach, subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at antrum and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, well differentiated (WHYX lesion)
4. Histologic type by Lauren : intestinal
5. Size : 0.9x0.4 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 9.3 cm, distal 3.3 cm
8. Lymph node metastasis : no metastasis in 35 regional lymph nodes (pN0) (0/35: "1", 0/1; "3", 0/12; "4", 0/6; "4sb", 0/2; "5", 0/0; "6", 0/3; "7", 0/1; "8a", 0/1; "9", 0/4; "11p", 0/2; "12a", 0/1; "greater curvature", 0/2)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: T1a N0


[2023-6-11] Ulcer findingÀº ¿¬±¸¸¶´Ù ±× ºóµµ°¡ ´Ù¸¨´Ï´Ù. ÆÇÁ¤ ±âÁØÀÌ ´Ù¸£´Ù´Â À̾߱âÀÔ´Ï´Ù.

¾È¼ö¹Î ±³¼ö´Ô °­ÀÇ


[References]

1) EndoTODAY Undifferentiated-type Á¶±âÀ§¾ÏÀÇ ¸²ÇÁÀý ÀüÀÌ À§Çè

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.