近端胃大部切除与全胃切除术治疗SiewertⅡ型食管胃结合部腺癌术后生存率的比较

Survival rate of proximal and total gastrectomy in treatment of esophagogastric junction adenocarcinoma （Siewert ⅡTypes）

目的比较根治性近端胃大部切除与根治性全胃切除术治疗SiewertⅡ型食管胃结合部（EGJ）腺癌患者术后生存率的差异，为临床选择提供参考。 方法回顾性分析2008年5月至2014年3月间第四军医大学西京消化病医院行根治性手术治疗、且经病理证实为SiewertⅡ型EGJ腺癌、并具有完整随访资料的533例患者的临床病理资料。根据年龄、性别、肿瘤大小、TNM分期和分化程度匹配后，共234例患者纳入分析，其中接受根治性近端胃大部切除术（近端胃大部切除组）和根治性全胃切除术（全胃切除组）各117例。比较两组术后的生存率。 结果近端胃大部切除组和全胃切除组的3年生存率分别为65.6％和62.6%，5年生存率分别为53.8％和44.5%，两组差异无统计学意义（P= 0.768）。进一步行分层生存比较，肿瘤直径≤4 cm者近端胃大部切除组和全胃切除组3年生存率分别为72.8％和80.4% （P= 0.423），肿瘤直径〉 4 cm者分别为57.9％和46.5%（P= 0.239）；高分化腺癌者分别为83.3％和83.3% （P= 0.998），中分化者分别为68.2％和53.3%（P= 0.270），低分化者分别为56.1％和69.6%（P= 0.280），黏液腺癌者分别为64.8％和56.0%（P= 0.451）；T1-2期腺癌者分别为80.0％和76.9%（P= 0.912），T3期者分别为64.3％和60.4%（P= 0.610），T4a期者分别为50.0％和62.5%（P= 0.953）；Ⅰ期腺癌者分别为92.3％和100% （P= 0.380），Ⅱ期者分别为79.6％和66.3%（P= 0.172），Ⅲ期者分别为42.6％和49.5%（P＝0.626）；差异均无统计学意义。 结论近端胃大部切除和全胃切除术治疗SiewertⅡ型EGJ腺癌患者术后生存率相当。

ObjectiveTo compare the survival rate of proximal gastrectomy and total gastrectomy in the treatment of esophagogastric junction （EGJ）adenocarcinoma （Siewert Ⅱ types）, and to provide reference for clinical choice. MethodsA total of 533 patients with Siewet Ⅱ type EGJ adenocarcinoma were screened. All the patients underwent radical operations and were pathologically diagnosed as Siewet Ⅱ type EGJ adenocarcinoma in Xijing Hospital of Digestive Diseases from May 2008 to March 2014. These patients all had complete followed-up data. Finally, 234 patients were enrolled into the retrospective study, and divided into proximal gastrectomy group （117 patients）and total gastrectomy group （117 patients）based on the matching of age, sex, tumor size, TNM staging, and differentiation. The survival rate was compared between the two groups. ResultsIn proximal gastrectomy and total gastrectomy group, the overall 3-year survival rate was 65.6% and 62.6% respectively, and the overall 5-year survival rate was 53.8% and 44.5% respectively. No significant difference was found between the two groups （P = 0.768）. In subgroup analyses of 3-year survival rate between proximal gastrectomy group and total gastrectomy group, the results were as follows： 72.8% and 80.4% respectively （P = 0.423）for tumor diameter≤4 cm, 57.9% and 46.5% （P = 0.239）for tumor diameter 〉 4 cm, 83.3% and 83.3% （P = 0.998）for high differentiated EGJ adenocarcinoma, 68.2% and 53.3% （P = 0.270）for moderate differentiated EGJ adenocarcinoma, 56.1% and 69.6% （P = 0.280）for poorly differentiated EGJ adenocarcinoma, 64.8% and 56.0% （P = 0.451）for mucinous EGJ adenocarcinoma, 80.0% and 76.9% （P = 0.912）for T1-2 stage EGJ adenocarcinoma, 64.3% and 60.4% （P = 0.610）for T3 stage, 50.0% and 62.5% （P = 0.953）for T4a stage, 92.3% and 100% （P=0.380）for stage Ⅰ EGJ adenocarcinoma, 79.6% and 66.3% （P = 0.172）for stage Ⅱ, 42.6% and 49.5% （P = 0.626）for stage Ⅲ. All above differences between the two groups were not significant （all P 〉 0.05）. ConclusionProximal gastrectomy and total gastrectomy are comparable in terms of 3-year and 5-year survival rates.