/ 55 40 The Burden of Cancer in China, Pfizer Facts, 2008 ; 1.4-1.5 2070700 000-20300 2010 :, Wen., Lancet Oncology, 2005 (),
(nitrosamines) / (nitrite) : (selenium) : (fungi toxin) (HPV) 16, 18, 73 14% 15% 26% 29% 44% 48% Cheng KK et al, Lancet 1992 5 ( ) 1 2 36 ALDH2* 1 / *2+ + 23 190 ALDH2*1/*1 : ALDH2*1/*2 + ALDH2*2/*2 ++ 0.5 0.2 1975 1980 1985 1990 1995 Devesa et al, Cancer, 1998
( : Barrett s esophagus West() ()East Locke et al. 1997 Wong WM, et al. 2003
40% SCMP 2005 / A C A (pernicious anaemia) - : 2005 (vit. A, C) /
/ Normal Wang 2004 Shao 1993 86% 75% 65% 56% 50% Wang GQ, Ann Thorac Surg, 2004 (m1, 2, 3; sm1) -- <5 > 90 > 50 >50
/ +/ - (AFI) +/ - (AFI) / +
(EMR) (ESD) (RFA) --- -- VS SB knife IT2 knife Hook knife Co-grasper Flexi-knife Dual knife + HALO 360 HALO 90 Gotoda et al. J Gastroenterol. Hepatol 2010; 25:1348-1357
Pre-RFA ( ) BE-LGD 4 cm Post-RFA ( ): 2 years CR-IM and CR-D Zhang YM et al., Endoscopy 2011 Torek, Surg Gynecol Obstet, 1913
N=156 (%) 28 (17.9) 2 (1.3) 4 (2.6) 8 (5.1) 1 (0.6) 30 0 (0) 1 (1.2) : : = 149:26, = 65 (38-82) N=175(%) 132(75.4) 35(20) 8(4.6) 30 0 (0) 1 (0.6) 5 : 40% vs. 22% : 19% vs. 29% Tong et al., Ann Surg Oncol, 2010 McDonald NEJM 2001, ASCO 2009
Adjuvant S1 Trial ACTS-GC Overall survival + S1 1 HR : 0.68 (0.52-0.87) HR 0.75 (0.60-0.93) 5 36% vs. 23% Sakuramoto, NEJM, 2007 NEJM 2006 JCOG 9205, 2001 Wagner,2006 Van Cutsem (V325), 2006 Koizumi (SPIRITS), 2008 Cunningham (REAL-2), 2008 Van Cutsem (ToGA), 2009 JCOG9912, 2007/2009 Cisplatin and 5FU Epirubicin, Cisplatin, 5FU (ECF) Docetaxol, Cisplatin, 5FU (DCF) S1, Cisplatin Epirubicin, Oxiliplatin, Capecitabine (EOX) 5 FU or Capecitabine + Cisplatin + Trastuzumab (Her-2 +ve) S1, CDDP, CPT-11
LAPAROTOMY Up to the 1990s LAPAROSCOPY 1990s Today NATURAL ORIFICE Next step 4
P=0.004 Law WL et al, Int J Colorectal Dis (in press) Di Vinci Di Vinci 2080