论文部分内容阅读
目的探讨食管胃结合部腺癌(AEG)不同Siewert亚型间临床病理特征、手术治疗方式及预后方面的差异。方法回顾性分析北京肿瘤医院2002年1月至2008年12月接受外科手术切除的471例AEG病人的临床资料,比较不同Siewert亚型的临床病理特征、手术治疗方式及预后。结果全组471例病人中,SiewertⅠ型22例(4.7%),SiewertⅡ型237例(50.3%),SiewertⅢ型212例(45.0%)。病人的年龄、性别比和体重指数在各组间差异无统计学意义。Ⅲ型较Ⅱ型更容易出现胃壁深层浸润和胃周淋巴结转移,故Ⅲ型比Ⅱ型具有更晚的TNM分期。组织分化程度为G3/4的病人在Ⅲ型中所占的比例明显高于Ⅱ型,脉管癌栓阳性率在Ⅲ型中同样明显高于Ⅱ型。不同的Siewert亚型通常选择不同的手术路径和切除方式。Siewert各亚型病人的5年存活率差异无统计学意义(P=0.308)。对于行R0切除的Ⅱ型和Ⅲ型病人,经腹手术病人的5年存活率优于经胸手术(49.1%vs.23.3%,P=0.045),而行近端胃大部切除和全胃切除的病人相比,5年存活率差异无统计学意义(40.1%vs.42.5%,P=0.278)。结论Ⅱ型和Ⅲ型AEG具有不同的临床病理学特征,但两组病人的5年存活率差异无统计学意义,可能与随访时间较短有关。对于Ⅱ型和Ⅲ型AEG,建议经腹实施手术,并根据肿瘤的浸润范围选择合适的切除范围。
Objective To investigate the clinicopathological characteristics, surgical treatment and prognosis of different Siewert subtypes of esophagogastric junctional adenocarcinoma (AEG). Methods The clinical data of 471 AEG patients who underwent surgical resection from January 2002 to December 2008 in Beijing Cancer Hospital were retrospectively analyzed. The clinicopathological characteristics, surgical treatment and prognosis of different Siewert subtypes were compared. Results Among the 471 patients, Siewert type Ⅰ was found in 22 cases (4.7%), Siewert Ⅱ type in 237 cases (50.3%) and Siewert Ⅲ type in 212 cases (45.0%). The patient’s age, sex ratio and body mass index were not significantly different among the groups. Type III is more prone to deep gastric wall invasion and gastric lymph node metastasis, so type Ⅲ than type Ⅱ has a later TNM staging. The proportion of patients with tissue differentiation degree G3 / 4 was significantly higher than that of type Ⅱ. The positive rate of vascular cancer thrombus in type Ⅲ was also significantly higher than that of type Ⅱ. Different Siewert subtypes usually choose different surgical paths and resection methods. There was no significant difference in 5-year survival rates among Siewert subtypes (P = 0.308). For type II and type III patients underwent R0 resection, the 5-year survival rate of patients undergoing transabdominal surgery was superior to transthoracic surgery (49.1% vs.23.3%, P = 0.045), while proximal gastrectomy and total stomach There was no significant difference in 5-year survival rates between patients who underwent resection and surgery (40.1% vs 42.5%, P = 0.278). Conclusion The AEGs of type Ⅱ and Ⅲ have different clinicopathological features. However, there is no significant difference in the 5-year survival rates between the two groups, which may be related to the short follow-up time. For type A and type III AEG, it is recommended to transabdominal surgery, and according to the scope of tumor invasion to select the appropriate range of resection.