食管胃结合部腺癌471例Siewert分型临床

diffenent Siewert types. Results Among 471 cases, 22 (4.7%) cases were classified as type I, 237 (50.3%) as type Ⅱ
and 212 (45.0%) as type Ⅲ. The age, male to female ratio and BMI had no difference between the different types. The
0.308). As for type Ⅱ and type Ⅲ tumors underwent R0 resection, resection via laparotomy showed survival advantage over resection via thoracotomy (49.1% vs 23.3% , P=0.045), and the 5-year survival was similar between proximal subtotal gastrectomy and total gastrectomy (40.1% vs 42.5%, P=0.278). Conclusion Type Ⅱ and type Ⅲ tumors have
· 310 ·
论著
文章编号：1005-2208（2012）04-0310-06
中国实用外科杂志 2012 年 4 月 第 32 卷 第 4 期源自文库
食管胃结合部腺癌 471 例 Siewert 分型临床研究
杨 宏 a，武爱文 a，季加孚 a，唐 磊 b，吴 齐 c
【摘要】 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%），Siewert Ⅱ型 237 例（50.3%），Siewert Ⅲ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。 【关键词】 食管胃结合部腺癌；Siewert 分型；临床病理；手术方式；预后 中图分类号：R6 文献标志码：A
depth of tumor invasion was deeper and the nodal metastases were more frequent in type Ⅲ compared with type Ⅱ,
which also meant type Ⅲ tumors demonstrated a more advanced stage than type Ⅱ. Moreover, the pathological grade was
Abstract Objective To clarify the different clinicalpathological characteristics, surgical procedures and prognosis of
adenocarcinoma of the esophagogastric junction (AEG) according to Siewert classification. Methods The clinical data
of 471 cases of AEG underwent resection from January 2002 to December 2008 in Beijing Cancer Hospital were
analyzed retrospectively. Clinical pathological characteristics, surgical procedures and prognosis were compared between
Adenocarcinoma of the esophagogastric junction according to Siewert classification: a clinical study of 471 cases YANG Hong*，WU Ai-wen，JI Jia-fu，et al. *Department of Surgery，Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)，Peking University Cancer Hospital & Institute,Beijing 100142，China Corresponding author: JI Jia-fu，E-mail:jiafuj@hotmail.com
higher and the lymphovascular invasion was more frequent in type Ⅲ than type Ⅱ. Surgical approaches and procedures differed among different Siewert types. The 5-year survival showed no significant difference among different subtypes (P=