Clinicopathological Features and Prognostic Factors of Adenocarcinoma of the Esophagogastric Junction According to Siewert Classification: Experiences at a Single Institution in Japan
Clinicopathological Features and Prognostic Factors of Adenocarcinoma of the Esophagogastric Junction According to Siewert Classification: Experiences at a Single Institution in Japan
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DOI：
10.1245/s10434-011-1983-x
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发表时间：
2012-02-01
影响因子：
3.7
通讯作者：
Kinoshita, Taira
中科院分区：
文献类型：
--
作者：
Hosokawa, Yuichi;Kinoshita, Takahiro;Kinoshita, Taira
食管胃结合部腺癌（AEG）的治疗策略仍存在争议。本研究的目的是评估 AEG 的手术结果，根据 Siewert 分类阐明临床病理差异，并确定预后因素。我们回顾性分析了 1993 年 1 月至 2008 年 12 月期间在国立癌症中心东医院接受根治性 (R0) 切除术的连续 179 例 Siewert I、II 和 III 型 AEG 患者。AEG 患者根据肿瘤分为：10 I 型（5.6%）、II 型 107 例（59.8%）和 III 型 62 例（34.6%）。较大、较深的肿瘤和淋巴结转移在 III 型肿瘤中比 II 型肿瘤更常见。 I型（51.4%）、II型（51.8%）和III型（62.6%）三种类型的5年生存率没有显着差异。多因素分析显示肿瘤深度和纵隔淋巴结转移是独立的预后指标。纵隔淋巴结转移患者的复发率为87.5%。纵隔淋巴结转移的危险因素是食管侵犯长度和组织病理学分级。纵隔淋巴结转移和肿瘤深度是AEG R0切除后不良预后的重要独立因素。食管侵犯和组织病理学分级是纵隔淋巴结转移的显着且独立的因素。
Treatment strategy for adenocarcinoma of the esophagogastric junction (AEG) remains controversial. The aims of this study are to evaluate results of surgery for AEG, to clarify clinicopathological differences according to the Siewert classification, and to define prognostic factors.We retrospectively analyzed 179 consecutive patients with Siewert type I, II, and III AEG who underwent curative (R0) resection at the National Cancer Center Hospital East between January 1993 and December 2008.Patients with AEG were divided according to tumor: 10 type I (5.6%), 107 type II (59.8%), and 62 type III (34.6%). Larger, deeper tumors and nodal metastasis were more common in type III than type II tumors. No significant differences were seen in 5-year survival rates among the three types: type I (51.4%), type II (51.8%), and type III (62.6%). Multivariate analysis showed that depth of tumor and mediastinal lymph node metastasis were independent prognostic indicators. The recurrence rate for patients with mediastinal lymph node metastasis was 87.5%. The risk factors for mediastinal lymph node metastasis were length of esophageal invasion and histopathological grade.Mediastinal lymph node metastasis and tumor depth were significant and independent factors for poor prognosis after R0 resection for AEG. Esophageal invasion and histopathological grade were significant and independent factors for mediastinal lymph node metastasis.