SiewertⅡ/Ⅲ型食管胃结合部腺癌淋巴结转移及预后的影响因素分析

Analysis of factors influencing lymph node metastasis and prognosis of SiewertⅡ/Ⅲesophagogastric junction adenocarcinoma

目的探讨影响SiewertⅡ/Ⅲ型食管胃结合部腺癌患者淋巴结转移及预后的危险因素。方法回顾性分析首都医科大学附属北京友谊医院2013年7月-2022年12月手术治疗的239例SiewertⅡ/Ⅲ型食管胃结合部腺癌患者的临床资料,其中男性204例,女性35例,年龄27~83岁,平均年龄63.1岁。采用SPSS 26.0软件对数据进行统计分析,计数资料以例(百分比)[例(%)]表示,并通过χ^(2)检验、校正χ^(2)检验或Fisher精确检验进行比较。等级资料以(百分比)[例(%)]表达,并使用秩和检验进行比较。采用Logistics检验进行多因素分析,并通过Cox回归模型进行生存分析。每6个月随访一次,随访截至2023年11月。结果多因素分析显示浸润深度(OR=0.038,95%CI:0.011~0.139,P<0.001)、癌结节(OR=0.101,95%CI:0.011~0.904,P=0.040)、脉管内癌栓(OR=0.234,95%CI:0.108~0.507,P<0.001)是淋巴结转移的独立危险因素。第1、2、3、4、7、10、11组淋巴结在腹腔内更易发生转移。与SiewertⅡ型相比,SiewertⅢ型食管胃结合部腺癌患者第5、6组淋巴结的转移率更高。SiewertⅡ型食管胃结合部腺癌患者中纵隔淋巴结转移主要见于第110、111组淋巴结,分别为5.45%和3.64%。3年生存分析显示淋巴结转移是一个重要的预后因素(P=0.001)。结论SiewertⅡ型食管胃结合部腺癌患者应同时清扫腹腔和纵隔淋巴结,特别是第1、2、3、4、7、10、11、110和111组淋巴结,不需要清扫5组和6组淋巴结。相反,SiewertⅢ型食管胃结合部腺癌患者不需要纵隔淋巴结清扫,但对5组和6组淋巴结进行幽门淋巴结清扫是必要的。淋巴结转移影响患者远期预后,围手术期化疗可能为患者提供生存优势。

ObjectiveTo explore the factors influencing lymph node metastasis and prognosis in patients with Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction(AEG).MethodsA retrospective analysis was conducted on clinical data of 239 patients with Siewert TypeⅡ/Ⅲadenocarcinoma of the esophagogastric junction who underwent surgical treatment at Beijing Friendship Hospital,Capital Medical University,from July 2013 to December 2022.Among them,there were 204 males and 35 females.The patients′ages ranged from^(2)7 to 83 years,with a mean age of 63.1 years.Statistical analysis was performed using SPSS 26.0 software,with categorical data presented as n(%)and compared usingχ^(2) tests,correctedχ^(2) tests,or Fisher′s exact tests.Ordinal data were expressed as frequencies and percentages and compared using rank-sum tests.Multivariate analysis was conducted using Logistic regression,and survival analysis was performed using the Cox regression model.Follow-up was conducted every 6 months,with the last follow-up conducted in November 2023.ResultsMultivariate analysis identified infiltration depth(OR=0.038,95%CI:0.011-0.139,P<0.001),tumor deposit(OR=0.101,95%CI:0.011-0.904,P=0.040)and intravascular cancer embolus(OR=0.234,95%CI:0.108-0.507,P<0.001)as independent predictors of LNM.Lymph nodes No.1,2,3,4,7,10,and 11 were more prone to metastasis in the abdominal cavity.Notably,SiewertⅢAEG patients showed a higher metastatic rate in nodes No.5 and No.6 compared to SiewertⅡ.Mediastinal LNM was predominantly found in nodes No.110 and No.111 for SiewertⅡAEG,with rates of 5.45%and 3.64%,respectively.A three-year survival analysis underscored LNM as a significant prognostic factor(P=0.001).ConclusionsSiewertⅡAEG patients should undergo removal of both celiac and mediastinal lymph nodes,specifically nodes No.1,2,3,4,7,10,11,110,and 111.Dissection of nodes No.5 and No.6 is not indicated for these patients.In contrast,SiewertⅢAEG patients do not require mediastinal LND,but pyloric lymphadenectomy for nodes No.5 and No.6 is essential.The presence of LNM is associated with poorer long-term prognosis.Perioperative chemotherapy may offer a survival advantage for AEG patients.