食管胃结合部癌与非结合部胃癌临床病理特征差异

Clinicopatholigical differences between patients with adenocarcinoma of esophagogastric junction and gastric cancer without esophagogastric junction invasion

目的探讨食管胃结合部癌(AEG)与非结合部胃癌临床病理及手术特征差异,以及其各自与幽门螺杆菌(Hp)感染、体重指数的关系。方法回顾性分析2013年12月—2019年2月绵阳市第三人民医院收治的577例胃癌患者的病例资料,根据肿瘤部位分为AEG组(n=218)和非AEG组(n=359),比较两组患者的年龄、性别、体重指数、Hp感染、病理分期、手术方式、术中出血量等特征差异。通过非条件logistic回归比较Hp感染及体重指数在AEG与非AEG患者中的差异,并计算其OR值及95%CI。结果AEG占总体胃癌的37.8%,单因素分析显示,相较于非AEG,AEG更多见于男性及老年人,具有多选择开放手术,更长手术持续时间及更多围手术期输血的特点,而非AEG患者具有更高的Hp感染率及家族胃癌病史。在调整了性别、年龄及家族史的影响后,非结合部胃癌患者中具有较高的Hp感染率,是AEG患者的1.73倍(95%CI:1.22~2.46,P<0.05),而单因素及多因素分析结果均显示超重及肥胖方面差异无统计学意义。结论AEG与非AEG具有不同的临床病理特征及发病机制,在诊治方面需要区别对待。

Objective To investigate the clinicopatholigical differences between patients with adenocarcinoma of esophagogastric junction(AEG)and gastric cancer without esophagogastric junction invasion,and relationship between the two type cancers and Helicobacter pylori(Hp)infection,body mass index.Methods A retrospective analysis was performed on 577 cases of gastric cancer patientsin the Third Hospital of Mianyang from December 2013 to February 2018.Patients were divided into AEG group(n=218)and gastric cancer without esophagogastric junction invasion group(n=359)according to location of neoplasm.The age,gender,body mass index,Hp infection,pathological stage,operative type and blood loss in operation of patients between two groups were compared,and the relationship between the two type cancers and Hp infection,body mass index was analyzed by logistic regression,OR and 95%CI:was calculated.Results AEG patients were accounted for 37.8%,and had a relatively higher percentage of males,older age,more open surgery,surgery duration and perioperative transfusion,and a relatively lower percentage of Hp infection and family history of gastric cancers.When adjusted for age,gender and family history,the frequency of infection with Hp was higher in patients with gastric cancer without esophagogastric junction invasion,the OR was 1.73(95%CI:1.22-2.46,P<0.05),while the differences of BMI was not significant between patents in two groups.Conclusion The different characteristics of AEG and gastric cancer without esophagogastric junction invasion cases have implications for the development of guiding strategies for diagnosis and treatment of gastric cancer patients based on tumor location.