CAJ | 학술논문

目的探讨食管-胃连接部(EGJ)恶性肿瘤的临床病理特征、Siewert分型与预后的关系,探讨新版美国癌症联合委员会(AJCC)分期指南在我国EGJ恶性肿瘤中的适用性.方法回顾性分析2002年至2012年间218例有完整随访资料的EGJ恶性肿瘤患者的临床资料、病理特征、治疗和预后情况.按照Siewert分型对患者分型,AJCC第7版AJCC食管腺癌和胃癌TNM分期标准分别对各病例进行分期,采用Kaplan Meier法和Log-rank检验进行生存分析.结果 218例EGJ恶性肿瘤按照Siewert分型,Ⅰ型仅9例(4.1％);Ⅱ型最多见,为1 50例(68.8％);Ⅲ型59例(27.1％).3种Siewert 分型的病例之间生存曲线差异无统计学意义(P＞0.05).按照AJCC第7版食管腺癌分期标准分组绘制生存曲线发现,在T分期中,T4b期的患者比T4a期的患者预后好;ⅡB期比ⅡA期的生存预后好;ⅢC期患者与Ⅳ期患者生存曲线存在明显的交叉,均与临床实际情况不符.按照AJCC第7版胃癌分期标准绘制生存曲线发现,在T分期中,Tis与T1a生存曲线重合;总体分期不能准确预测ⅡB期患者的生存.从总体上看,按照AJCC第7版胃癌分期标准预测EGJ恶性肿瘤患者生存的能力好于按AJCC第7版食管腺癌分期标准.结论我国的EGJ恶性肿瘤更接近胃癌,且有其独特的临床病理学特征,AJCC第7版分期指南中所参照的食管腺癌分期标准和胃癌分期标准均不能准确提示其预后.有必要研究并建立适用于EGJ恶性肿瘤的分期标准,而不是仅参照现有的食管癌或胃癌标准.
목적 탐토식관-위련접부(EGJ)악성종류적림상병리특정、Siewert분형여예후적관계,탐토신판미국암증연합위원회(AJCC)분기지남재아국EGJ악성종류중적괄용성.방법 회고성분석2002년지2012년간218례유완정수방자료적EGJ악성종류환자적림상자료、병리특정、치료화예후정황.안조Siewert분형대환자분형,AJCC제7판AJCC식관선암화위암TNM분기표준분별대각병례진행분기,채용Kaplan Meier법화Log-rank검험진행생존분석.결과 218례EGJ악성종류안조Siewert분형,Ⅰ형부9례(4.1％);Ⅱ형최다견,위1 50례(68.8％);Ⅲ형59례(27.1％).3충Siewert 분형적병례지간생존곡선차이무통계학의의(P＞0.05).안조AJCC제7판식관선암분기표준분조회제생존곡선발현,재T분기중,T4b기적환자비T4a기적환자예후호;ⅡB기비ⅡA기적생존예후호;ⅢC기환자여Ⅳ기환자생존곡선존재명현적교차,균여림상실제정황불부.안조AJCC제7판위암분기표준회제생존곡선발현,재T분기중,Tis여T1a생존곡선중합;총체분기불능준학예측ⅡB기환자적생존.종총체상간,안조AJCC제7판위암분기표준예측EGJ악성종류환자생존적능력호우안AJCC제7판식관선암분기표준.결론 아국적EGJ악성종류경접근위암,차유기독특적림상병이학특정,AJCC제7판분기지남중소삼조적식관선암분기표준화위암분기표준균불능준학제시기예후.유필요연구병건립괄용우EGJ악성종류적분기표준,이불시부삼조현유적식관암혹위암표준.
Objective To explore the relation between clinical-pathological features,Siewert classification and prognosis of esophagogastric junction (EGJ) carcinoma,and to assess the applicability of the new edition of American Joint Committee of Cancer (AJCC) staging guideline on EGJ adenocarcinoma in China.Methods From 2002 to 2012,the clinical data,pathological features,treatment and prognosis of 218 patients with EGJ malignant tumor were retrospectively analyzed.The patients were typed according to Siewert classification criteria and each case was staged according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma and gastric cancer.Kaplan-Meier method and Log-rank test were performed for survival analysis.Results According to the Siewert classification,type Ⅰ was rare (nine cases,4.1％),type Ⅱ was the most common type (150 cases,68.8％) and followed by type Ⅲ (59 cases,27.1％).There was no significant difference in survival curve among the three types (P＞0.05).The survival curve was drawn according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma.In T staging,the prognosis of patients at T4b was better than that of patients at T4a,the prognosis of patients at ⅡB was better than that of patients at ⅡA.The survival curve of patients at Ⅲ C obviously crossed with that of patients at Ⅳ,which was not in conformity with clinical results.The survival curve was drawn according to 7th edition of AJCC staging criteria for gastric cancer.In T staging,the survival curve of patients at Tis was overlapped with that of patients at T1a.The survival rate of patients at ⅡB could not be accurately predicted by the overall staging.In general,the survival of patients with EGJ carcinoma was better predicted according to 7th edition of AJCC staging criteria for gastric cancer than 7th edition for esophagus adenocarcinoma.Conclusions Neither 7th edition of AJCC staging criteria for esophagus adenocarcinoma nor for gastric cancer could accurately predict its prognosis.In our country,EGJ malignant tumor was similar to gastric cancer and had specific clinical-pathological features.It is necessary to research and establish EGJ carcinoma staging criteria instead of applying the current staging criteria for esophagus adenocarcinoma or gastric cancer.