食管胃结合部腺癌的定义、分型和分期:争议中的进展

Definition, classification, and staging for adenocarcinoma of esophagogastric junction:updates in controversies

目的食管胃结合部腺癌(AEG)在临床病理特点、生物学特性、分型、TNM分期、外科治疗方式等多方面存在诸多争议,现拟梳理AEG定义、分型、分期的最新研究进展。方法对近年来关于AEG的指南、共识、国际会议报道、临床研究的相关知识进行归纳和总结。结果 AEG是一种特殊部位的恶性肿瘤,国内关于AEG的WHO定义以往存在误读,需要得到纠正和统一。Siewert分型仍然是当前临床较为实用的分型方法,日本JGCA分型的新版修订需要在实践中评估和验证。相比之下第8版AJCC/UICC分型对指导临床治疗策略的实用性相对争议较大,争议主要来自于SiewertⅡ型的分期、手术入路、淋巴结清扫范围等。基于已有研究结果,对于SiewertⅡ、Ⅲ型AEG按照胃癌的第8版TNM分期系统倾向于更为合理。结论随着AEG发病率的增高,更多有关AEG的基础和临床研究正在开展,期待将来有AEG更优化的分型系统和专属的分期系统。

Objectives To summarize the latest advances about definition, classification, and TNM stage of adenocarcinoma of esophagogastric junction(AEG). Method The available guidelines, consensuses, international conference proceedings, and clinical studies were reviewed and summarized. Results The AEG trended to be an independent entity of malignant tumor at the special location. The previous misunderstanding of AEG definitions from the WHO needed to be corrected and unified in China. The Siewert classification was still a practical clinical approach to guiding treatment strategy, while the new draft of JGCA classification needed to be evaluated and verified in the clinical practice. By contrast, the 8 th edition AJCC/UICC classification was relatively controversial in the guiding treatment strategies, mainly due to the staging system, surgical approach, and extent of lymphadenectomy of Siewert Ⅱ type AEG.Based on the available research results, the TNM staging system of the 8 th edition of gastric cancer tended to be more reasonable for the Siewert Ⅱ and Ⅲ types AEG. Conclusion With increasing incidence of AEG, more experimental and clinical studies on AEG are ongoing, and it is expected to have more optimized classification and exclusive staging system for AEG in future.