Adenocarcinomas of the distal esophagus and "gastric cardia" are predominantly esophageal carcinomas
Adenocarcinomas of the distal esophagus and "gastric cardia" are predominantly esophageal carcinomas
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DOI：
10.1097/01.pas.0000213394.34451.d2
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发表时间：
2007-04-01
影响因子：
5.6
通讯作者：
DeMeester, Tom
中科院分区：
文献类型：
--
作者：
Chandrasoma, Parakrama;Wickramasinghe, Kumari;DeMeester, Tom
背景：食管腺癌是由其震中与胃-食道交界处的关系来定义的，目前定义为管状食管端。目的：根据肿瘤与胃氧合黏膜近端界限的关系，对该地区的腺癌进行重新分类。方法：根据现有的诊断标准，将74例因腺癌而行食管胃切除手术的患者分为食道远端腺癌38例和贲门癌36例。结果：非周围型肿瘤的中心有鳞状上皮(5例)、心脏上皮(21例)、氧心上皮(4例)和肠上皮(Barrett型)(34例)。无一例出现胃氧合黏膜。在10例环状肿瘤患者中，7例在肿瘤远端边缘有心脏或氧合-心上皮。结论：如果组织学上将胃-食道交界处定义为氧合黏膜的近端界限，71/74例患者可被归类为食道远端腺癌。另有3例疑似起源于胃或食道。我们认为，基于对胃-食道交界处的新定义进行的重新分类，为“胃-食道”腺癌和胃-食道反流病之间存在的表皮学关系提供了解释。
Background: Adenocarcinoma of the distal esophagus and gastric cardia are defined by the relationship of its epicenter to the gastro-esophageal junction, which is presently defined as the end of the tubular esophagus. We have recently suggested that the true gastro-esophageal junction is best defined by the proximal limit of gastric oxyntic mucosa.Aim: To reclassify adenocarcinomas of this region by the relationship of the tumor to the proximal limit of gastric oxyntic mucosa.Methods: Seventy-four patients who had esophago-gastrectomy for adenocarcinomas in this region were classified as adenocarcinoma of distal esophagus (38 patients) and gastric cardia (36 patients) by present criteria. The epithelial type at the epicenter and distal edge of these tumors was assessed.Results: The epicenter of the tumor in 64 patients with noncircumferential tumors had squamous (5 cases), cardiac (21 cases), oxymo-cardiac (4 cases), and intestinal (Barrett-type) (34 cases) epithelia. None had gastric oxyntic mucosa. Of the 10 patients with circumferential tumors, 7 had cardiac or oxyntocardiac epithelium at the distal tumor edge.Conclusions: If the gastro-esophageal junction is defined histologically as the proximal limit of oxyntic mucosa, 71/74 patients would be classified as adenocarcinoma of the distal esophagus. The other 3 patients were questionable as to gastric or esophageal origin. We suggest that this reclassification based on the proposed new definition of the gastro-esophageal junction provides an explanation for the epiderniologic relationship that exists between adenocarcinorna of the "gastric cardia" and gastro-esophageal reflux disease.