Ⅱ/Ⅲ型食管胃连接处腺癌术后复发转移的影响因素分析

Analysis of related factors for postoperative recurrence and metastasis of type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction

目的探讨SiewertⅡ/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例患者的术后随访时间为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,组织学分级(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。结论组织学分级、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 Siewert Ⅱ and Ⅲadenocarcinoma of esophagogastric junction（AEG） after radical gastrectomy.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 radical gastrectomy were analyzed by the unconditional logistic regression analysis.Results The 146 AEG 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 and metastasis time was 1–50 months after radical gastrectomy,with the median time of 17 months after radical gastrectomy.The results of multivariate logistic regression analysis showed that,the histological grade（OR=4.478,P=0.015）,the number of positive lymph nodes（OR=2.886,P0.001）,and vascular invasion（OR=5.334,P=0.003） were independent risk factors for the recurrence and metastasis of AEG patients after radical gastrectomy.Patients with low tumor histological grade（G3＋G4）,a large number of positive lymph nodes,and vascular invasion were more likely to have recurrence and metastasis after radical gastrectomy.Conclusions The histological grade of tissue,number of positive lymph nodes,and vascular invasion are important factors in predicting the recurrence and metastasis of Siewert Ⅱ/Ⅲ AEG patients after radical gastrectomy.