食管胃结合部腺癌122例Siewert分型及临床病理特征和预后分析

Siewert classification,clinicopathological features and prognosis of adenocarcinoma of esophagogastric junction:a report of 122 cases

目的分析食管胃结合部腺癌病人的Siewert分型及临床病理特征和预后,为食管胃结合部腺癌的临床干预提供参考依据。方法回顾性研究安徽济民肿瘤医院自2014年9月至2016年4月收治的122例食管胃结合部腺癌病人,将符合标准的食管胃结合部腺癌病人按Siewert分型分组,其中Ⅰ型15例、Ⅱ型32例、Ⅲ型75例;比较三组临床病理特征、治疗情况,绘制Kaplan-Meier生存曲线分析三组生存率;并分别采用单因素、多因素Cox分析食管胃结合部腺癌病人预后的影响因素。结果 Siewert Ⅱ型、Siewert Ⅲ型中体质量指数(BMI)>22.7 kg/m2比例为56.25%(18/32)、58.67%(44/75),显著高于SiewertⅠ型的20.00%(3/15);软组织浸润比例分别为18.75%(6/32)、24.00%(18/75),显著高于SiewertⅠ型的6.67%(1/15);Siewert Ⅲ型病人累积生存率为24.1%,显著低于Siewert Ⅰ型(75.0%)、Siewert Ⅱ型(59.5%)(P<0.05);单因素分析及多因素COX分析显示,肿瘤最大直径[HR(95%CI):0.551(0.307~0.990)]、肿瘤分化程度[HR(95%CI):2.152(1.057~5.841)]、肿瘤T分期[HR(95%CI):3.086(1.048~9.088)]、肿瘤TNM分期[HR(95%CI):1.069(0.577~1.983)]、淋巴结转移度[HR(95%CI):2.399(1.043~5.518)]、术后辅助化疗[HR(95%CI):4.354(1.294~14.647)]是食管胃结合部腺癌病人预后的独立影响因素(P<0.05)。结论不同Siewert分型的食管胃结合部腺癌病人临床病理也正存在一定差异,生存率可随分型的位置下移而下降,且预后与肿瘤最大直径、肿瘤分化程度、肿瘤分期、淋巴结转移度、术后辅助化疗密切相关,值得临床重视。

Objective To analyze the Siewert classification,clinicopathological features and prognosis of patients with adenocarcinoma of the esophagogastric junction,so as to provide reference for clinical intervention of the disease.Methods A total of 122 patients with adenocarcinoma of the esophagogastric junction who were admitted to Anhui Jimin Cancer Hospital between September2014 and April 2016 were enrolled in the retrospective study.Patients who met the criteria were grouped according to Siewert classification,including 15 cases with type Ⅰ,32 cases with type Ⅱ and 75 cases with type Ⅲ.The clinicopathological features and treatment were compared among the three groups.Kaplan-Meier survival curves were used to analyze the survival rates of the three groups.Factors influencing the prognosis of patients with adenocarcinoma of the esophagogastric junction were screened by univariate analysis and multivariate Cox analysis.Results The proportions of body mass index(BMI) higher than 22.7 kg/m2 in patients with Siewert type Ⅱand type Ⅲ were 56.25%(18/32) and 58.67%(44/75),signiifcantly higher than 20.00%(3/15) in patients with Siewert type Ⅰ.The proportions of soft tissue infiltration in patients with Siewert type Ⅱ and type Ⅲ were 18.75%(6/32) and 24.00%(18/75),significantly higher than 6.67%(1/15) in patients with Siewert type Ⅰ.The cumulative survival rate of patients with Siewert type Ⅲ was 24.1%,significantly lower than 75.0% of Siewert type Ⅰ and 59.5% of Siewert type Ⅱ(P<0.05).Univariate analysis and multivariate COX analysis results showed that the maximum tumor diameter [HR(95%CI):0.551(0.307-0.990)],tumor differentiation degree [HR(95%CI):2.152(1.057-5.841)],T stage [HR(95%CI):3.086(1.048-9.088)],TNM stage [HR(95%CI):1.069(0.577-1.983)],lymph node metastasis [HR(95%CI):2.399(1.043-5.518)] and postoperative adjuvant chemotherapy [HR(95%CI):4.354(1.294-14.647)] were independent influencing factors of the prognosis of patients with adenocarcinoma of the esophagogastric junction(P<0.05).Conclusions There are differences in clinicopathological features among patients with different Siewert types of adenocarcinoma of the esophagogastric junction.The survival rate decreases with the type.The prognosis is closely related to the maximum tumor diameter,tumor differentiation degree,T stage,TNM stage,lymph node metastasis and postoperative adjuvant chemotherapy.