中国普外基础与临床杂志

中国普外基础与临床杂志

Ⅱ/Ⅲ型食管胃连接处腺癌术后复发转移的影响因素分析

查看全文

目的 探讨Ⅱ/Ⅲ型食管胃连接处腺癌(AEG)患者根治术后出现复发转移的危险因素。 方法 回顾性分析 2010 年 1 月至 2013 年 1 月期间于江苏省南京市第一医院普外科行根治性手术治疗的 146 例Ⅱ/Ⅲ型 AEG 患者的临床资料,采用非条件 logistic 回归分析方法探索患者术后肿瘤复发转移的影响因素。 结果 本组 146 例患者术后随访时间为 3~84 个月,中位随访时间为 48 个月。随访期间复发转移 59 例,复发时间为术后 1~50 个月,中位复发时间为术后 17 个月。多因素 logistic 回归分析结果表明,分化类型(OR=4.478,P=0.015)、阳性淋巴结数目(OR=2.886,P<0.001)及脉管侵犯(OR=5.334,P=0.003)均是 AEG 根治术后复发转移的独立危险因素。G3+G4 级相对于 G1+G2 级、脉管侵犯相对于未侵犯者,其复发转移率高;此外,随着阳性淋巴结数目增加,复发转移率增高。 结论 组织分化类型、阳性淋巴结数目和脉管侵犯是预测Ⅱ/Ⅲ型 AEG 患者根治后复发转移的重要因素。

Objective To explore the risk factors of recurrence and metastasis in patients with type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical operation. Methods A retrospective study was conducted to collect the clinical data of 146 patients with type Ⅱ and Ⅲ AEG who underwent radical gastrectomy from January 2010 to January 2013 in the Nanjing First Hospital of Nanjing Medical University. The factors affected the recurrence and metastasis of the patients after the operation were analyzed by the unconditional logistic regression analysis. Results The 146 patients were followed up for 3–84 months, with the median follow-up time of 48 months. During the follow-up period, there were 59 cases suffered from recurrence and metastasis. The recurrence time was 1–50 months after operation, with the median time of 17 months after radical operation. The results of multivariate logistic regression analysis showed that, the differentiation type (OR=4.478, P=0.015), the number of positive lymph nodes (OR=2.886, P<0.001), and vascular invasion (OR=5.334, P=0.003) were independent risk factors for the recurrence and metastasis of AEG patients after radical resection. Patients with low tumor differentiation (G1+G2), a large number of positive lymph nodes, and vascular invasion were more likely to have recurrence and metastasis after operation. Conclusions The type of tissue differentiation, number of positive lymph nodes, and vascular invasion are important factors in predicting the recurrence and metastasis of type Ⅱ/Ⅲ AEG patients after radical resection.

关键词: 食管胃连接处腺癌; 复发转移; 影响因素

Key words: adenocarcinoma of esophagogastric junction; recurrence and metastasis; influencing factor

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA Oncol, 2015, 1(4): 505-527.
3. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
4. Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol, 2013, 23(1): 3-9.
5. Cook MB, Kamangar F, Whiteman DC, et al. Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst, 2010, 102(17): 1344-1353.
6. Maeda H, Okabayashi T, Nishimori I, et al. Clinicopathologic features of adenocarcinoma at the gastric cardia: is it different from distal cancer of the stomach? J Am Coll Surg, 2008, 206(2): 306-310.
7. Liu K, Zhang W, Chen X, et al. Comparison on clinicopathological features and prognosis between esophagogastric junctional adenocarcinoma (Siewert Ⅱ/Ⅲ types) and distal gastric adenocarcinoma: retrospective cohort study, a single institution, high volume experience in China. Medicine (Baltimore), 2015, 94(34): e1386.
8. Lagarde SM, Reitsma JB, Ten Kate FJ, et al. Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction. Ann Surg, 2008, 248(6): 1006-1013.
9. 黄永高, 王鹏程, 王嵩, 等. Ⅰ、Ⅱ型食管胃连接处腺癌根治性切除术后早期复发的相关因素分析. 中国癌症杂志, 2016, 26(5): 458-461.
10. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer, 2011, 14(2): 101-112.
11. Rüdiger Siewert J, Feith M, Werner M, et al. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
12. Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol, 2017, 12(1): 36-42.
13. Pedrazzani C, de Manzoni G, Marrelli D, et al. Lymph node involvement in advanced gastroesophageal junction adenocarcinoma. J Thorac Cardiovasc Surg, 2007, 134(2): 378-385.
14. 郭春光, 田艳涛. 食管胃结合部腺癌的外科治疗与争议. 中国医学前沿杂志(电子版), 2017, 9(5): 1-5.
15. Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
16. Hosoda K, Yamashita K, Moriya H, et al. Optimal treatment for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up. World J Gastroenterol, 2017, 23(15): 2723-2730.
17. 张洪典, 唐鹏, 陈传贵, 等. 进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素分析. 中华消化外科杂志, 2013, 12(10): 783-787.
18. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable esophageal cancer. J Gastrointest Surg, 2007, 11(11): 1384-1393.
19. Li P, Ling YH, Zhu CM, et al. Vascular invasion as an independent predictor of poor prognosis in nonmetastatic gastric cancer after curative resection. Int J Clin Exp Pathol, 2015, 8(4): 3910-3918.
20. Parnaby CN, Scott NW, Ramsay G, et al. Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection. Br J Cancer, 2015, 113(2): 212-219.
21. Lee JH, Kim MG, Jung MS, et al. Prognostic significance of lymphovascular invasion in node-negative gastric cancer. World J Surg, 2015, 39(3): 732-739.
22. Li ZG, Zhu H, Shi H, et al. Lymphovascular invasion and nodal metastasis in intramucosal adenocarcinoma of the esophagus and esophagogastric junction. J Dig Dis, 2015, 16(4): 197-204.
23. Nordenstedt H, El-Serag H. The influence of age, sex, and race on the incidence of esophageal cancer in the United States (1992-2006). Scand J Gastroenterol, 2011, 46(5): 597-602.
24. Bodelon C, Anderson GL, Rossing MA, et al. Hormonal factors and risks of esophageal squamous cell carcinoma and adenocarcinoma in postmenopausal women. Cancer Prev Res (Phila), 2011, 4(6): 840-850.
25. Rutegård M, Nordenstedt H, Lu Y, et al. Sex-specific exposure prevalence of established risk factors for oesophageal adenocarcinoma. Br J Cancer, 2010, 103(5): 735-740.
26. Löfdahl HE, Lu Y, Lagergren J. Sex-specific risk factor profile in oesophageal adenocarcinoma. Br J Cancer, 2008, 99(9): 1506-1510.
27. 刘尚国, 齐博, 赵宝生, 等. 食管癌根治术后早期复发转移的影响因素. 中国老年学杂志, 2016, 36(16): 3992-3994.
28. Forget P, Dinant V, De Kock M. Is the neutrophil-to-lymphocyte ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery? Peer J, 2015, 3: e713.
29. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.