河南贲门癌高发区贲门癌发生部位分析

Analysis on the occurrence site of gastric cardia adenocarcinoma in high incidence area in Henan

目的：分析河南贲门癌高发区贲门癌发生部位及其年龄和性别分布特征,加深对贲门癌,食管/贲门交界部腺癌以及食管下段原发性腺癌分类和分型的认识。方法：以食管鳞状上皮和贲门柱状上皮交界部的齿状线为参照,将贲门癌区分为4种类型A型肿瘤全部位于齿状线下方;B型肿瘤2/3位于齿状线下方;C型肿瘤1/2位于齿状线下方;D型肿瘤1/3位于齿状线下方。分析比较河南贲门癌高发区595例贲门癌患者肿瘤发生部位的分布特征。结果：595例贲门癌患者中,男女性比例为3.5∶1。男性和女性贲门癌发生部位均以A型和B型为主（〉95%）,高于C型和D型（P〈0.05）。青年贲门癌患者以A型为主（78%）,高于中老年患者（P〈0.05）。除男性和女性30-年龄段A型多于B型（P〈0.05）,女性60-年龄段B型多于A型（P〈0.05）外,其余男性和女性各年龄段A型和B型间差异均无统计学意义（P〉0.05）。结论：河南贲门癌高发区贲门癌95%以上属A型和B型,主要发生于解剖学贲门部位,与西方国家食管/贲门交界部腺癌发生部位明显不同,建议将贲门癌作为一种独立的疾病进行研究。

Aim： To analyze the occurrence site of gastric cardia adenocarcinoma （GCA） on different ages and sexes in high incidence area, Henan. Methods： Based on the junction of esophageal squamous epithelia and gastric cardia columnar epithelia （Z-line）, GCA was classified as four types, i.e. , type A： total of the tumor located below Z-line; type B： 2/3 of the tumor located below Z-line; type C： half of the tumor located below Z-line; and type D： 1/3 of the tumor located below Z-line. The relationship between location of GCA and age, sex was analyzed. Results： Among 595 GCA patients, the ratio for male to female was 3.5 ： 1 ; type A and B were predominant （ 〉 95% ） both in males and females, which were higher than type C and D （P 〈 0.05 ）. The detection rate of type A in young GCA patients （78%） was apparently higher than in other age groups （ P 〈 0.05 ）. The distribution of type A and B was similar both in males and in females in different age groups except in the age group of 30 - 39 years （ type A 〉 type B, P 〈 0.05 ）, and in female age group of 60 - 69 years （ type B 〉 type A ,P 〈 0.05 ）. Conclusion ： Type A and type B are predominant （ 〉 95% ） type of GCA in high incidence area for GCA in Henan, suggesting that these GCAs are true GCA, i.e. , occurring at anatomic site of gastric cardia, which is quite different from the adenocarcinoma occurring at gastroesophageal junction in western countries. GCA should be considered as a distinct clinic entity.