国际抗癌联盟一美国癌症联合委员会第7版食管癌和胃癌TNM分期系统在预测食管胃交界腺癌Siewert Ⅱ型患者预后中的价值

Evaluation of the value of 7th editions of UICC-AJCC esophageal and gastric cancer TNM staging systems for prognostic prediction of adenocarcinoma of esophagogastric junction（Siewert type Ⅱ）

目的比较国际抗癌联盟一美国癌症联合委员会（U1CC—AJCC）第7版食管癌TNM分期系统和UICC—AJCC第7版胃癌TNM分期系统在食管胃交界腺癌SiewertⅡ型预后判断中的价值。方法分析2007年6月至2010年12月间手术治疗并有随访资料的199例食管胃交界腺癌SiewertⅡ型患者的临床资料，应用UICC—AJCC第7版食管癌和胃癌TNM分期标准重新分期，用赤池信息标准（AIC）判断其预测预后的价值。结果199例患者中，男162例，女37例；中位年龄62岁；经胸手术176例，经腹手术23例；T1期4例，T2期39例，T3期139例，T4a期17例；N0期76例，N1期58例；N2期49例，N3期16例。全组患者的中位随访时间为30个月，1、3、5年生存率分别为95．0％、52．7％和39．2％。单因素分析显示，患者年龄、术前有无合并症、T分期、N分期、分化程度以及手术方式与患者的5年生存率有关（均P〈0．05）。多因素分析显示，T分期、N分期和术前有无合并症在第7版胃癌TNM分期系统和第7版食管癌TNM分期系统中均为独立的预后因素（均P〈0．05）。第7版食管癌和胃癌TNM分期系统各分期整体的生存曲线差异均有统计学意义（均P〈0．05）。第7版食管癌TNM分期系统的AIC值为961．4，低于第7版胃癌TNM分期系统（965．7）。结论UICC—AJCC第7版食管癌TNM分期系统在判断食管胃交界腺癌SiewertⅡ型预后方面的价值优于UICC-AJCC第7版胃癌TNM分期系统。

Objective To compare the value of applicability of the 7th edition of UICC-AJCC esophageal and gastric cancer TNM staging system in the prognostic prediction of adenocareinoma of esophagogastric junction （EGJ）. Methods During June 1, 2007 through Dec. 31, 2010, a total of 199 patients with adenoearcinoma of esophagogastric junction （Siewert type Ⅱ） underwent R0-intent resection from June 1, 2007 to Dec 31, 2010 in our hospital. Their clinicopathological and survival data were retrospectively analyzed with Kaplan-Meier and Cox regression models. They were restaged according to the 7th edition of UICC/AJCC TNM stage systems for esophageal adenocarcinoma and gastric cancer, respectively. Then the likelihood ratio chi-square test related to the Cox regression model and Akaike information criterion （AIC） were used for measuring goodness of fit for both staging systems. Results 199 patients with Siewert type Ⅱ esophagogastric junction adenoearcinoma were identified in this study. Out of them, there were 162 males and 37 females. Their age range was from 38 to 79 years, with a median age of 62 years. 176 cases underwent transthoracic surgery, and other 23 cases underwent transabdominal surgery. TNM-EC and TNM-GC classified 4 patients to stage T1, 39 to T2, 139 to T3, and 17 to T4a, respectively, and classified 76 patients to stage N0, 58 to N1, 49 to N2, 16 to N3, respectively. The median follow-up period was 30 months. The 1-, 3-, and 5-year survival rates were 95.0%, 52,7% and 39.2%, respectively. Univariate analysis indicated that age at surgery （ P = 0. 009 ）, surgical approach （ P =0,002 ）, cell differentiation （ P = 0. 030 ）, preoperative co-morbidity implications （ P = 0. 026 ）, depth of tumor invasion （ P 〈 0. 001 ） and number of metastatic lymph nodes （ P 〈 0. 001 ） were significantly influencing factors of postoperative overall survival. Multivariate analysis showed that the independent prognostic factors for adenocarcinoma of esophagogastric junction were only T stage, N stage and preoperative co-morbidity and morbidities according to the 7th edition of esophageal cancer or gastric cancer TNM staging systems. The AIC value was 961.4 for the 7th edition of esophageal adenocarcinoma caner staging system, and 965.7 for the 7th edition of gastric cancer staging system. Conclusions The UICC/AJCC 7th edition of esophageal adenocarcinoma cancer TNM classification staging system is superior to the 7th edition of gastric cancer TNM staging system for adenocarcinoma of esophagogastric junction.