目的本研究旨在比较近端胃切除术(proximal gastrectomy,PG)与全胃切除术(total gastrectomy,TG)对Siewert Ⅱ型食管胃交界处腺癌(Adenocarcinoma of the esophagogastric junction,AEG)的手术治疗效果,探讨PG在AEG治疗中的可行性与安...目的本研究旨在比较近端胃切除术(proximal gastrectomy,PG)与全胃切除术(total gastrectomy,TG)对Siewert Ⅱ型食管胃交界处腺癌(Adenocarcinoma of the esophagogastric junction,AEG)的手术治疗效果,探讨PG在AEG治疗中的可行性与安全性。方法本研究主要纳入了2016年02月至2020年06月于我院接受手术治疗的104例Siewert Ⅱ型AEG患者,根据手术方式的选择,将所有患者分为PG组(n=62)和TG组(n=42),比较两组患者的手术质量,围手术期结局与长期肿瘤学结果。结果两组患者在基线特征分布方面无显著差异,具有可比性(P>0.05)。两种手术方式在手术时间、术中失血量和术后并发症(Clavien-Dindo≥Ⅱ级)等方面无明显差异(P>0.05)。然而,与TG组相比,PG组患者住院时间更短(12[IQR:11,15]vs 15[IQR:14,19]天;t=-1.990,P=0.047),术后6、12个月的体重(6个月:47.8±5.9 vs 50.9±9.2 kg;t=2.090,P=0.039;12个月:46.4±6.4 vs 50.0±9.1 kg;t=2.367,P=0.020)、血清白蛋白(6个月:37.9±4.2 vs 39.3±4.6 g/L,t=2.257,P=0.026;12个月:37.4±3.5 g/L vs 38.9±3.2;t=2.296,P=0.024)及术后12个月的血红蛋白值更低(11.1±2.1 vs 12.2±1.5 g/dL;t=2.688,P=0.008),差异有统计学意义。生存分析表明PG组和TG组患者的3年无复发生存率分别为58.2%和67.4%,差异无统计学意义(χ^(2)=0.669,P=0.414)。结论与TG相比,PG在术后恢复及营养状况方面更有优势,而肿瘤学结果具有可比性。PG或许是治疗Siewert Ⅱ型食管胃交界处腺癌一种可选择的手术方式。展开更多
食管胃交界处腺癌(adenocarcinoma of esophagogastric junction,EGJA)有其独特的解剖学位置,同时又位于鳞状上皮与柱状上皮交界之处,其生物学特性不同于食管癌和胃癌,诊断分型一直存在众多的争议,治疗模式在学术界也始终没有公认的&qu...食管胃交界处腺癌(adenocarcinoma of esophagogastric junction,EGJA)有其独特的解剖学位置,同时又位于鳞状上皮与柱状上皮交界之处,其生物学特性不同于食管癌和胃癌,诊断分型一直存在众多的争议,治疗模式在学术界也始终没有公认的"金标准",特别是局部进展期EGJA的治疗策略更是难以抉择。随着影像学技术的发展和各项大型临床研究结果的公布,EGJA的治疗日益个体化,同时也凸显了多学科协作的重要性。本文将针对以上问题对EGJA的最近进展做一综述。展开更多
目的:探究Snail2、胰岛素样生长因子II mRNA结合蛋白3(insulin-like growth factor II mRNA-binding protein 3,IMP3)和Wnt通路抑制因子1(Wnt inhibitory factor-1,Wif-1)在食管胃交界处的腺癌(adenocarcinoma of the esophagogastric j...目的:探究Snail2、胰岛素样生长因子II mRNA结合蛋白3(insulin-like growth factor II mRNA-binding protein 3,IMP3)和Wnt通路抑制因子1(Wnt inhibitory factor-1,Wif-1)在食管胃交界处的腺癌(adenocarcinoma of the esophagogastric junction,AEG)中的表达特点及临床意义。方法:随机选择2017年3月至2019年3月间的AEG患者90例作为AEG组,收集同期正常胃组织50例作为健康组。患者经过手术或全身PET-CT检测AEG转移情况。通过免疫组化染色和Western blot检测组织中Snail2、Wif-1、IMP3的表达情况。结果:免疫组化研究结果显示Snail2主要表达于细胞核和细胞质,IMP3主要表达于细胞质,AEG组中Snail2和IMP3的表达水平显著升高。Wif-1在健康组中呈阳性表达,但是在AEG组中表达水平降低。性别、年龄以及肿瘤大小对AEG组织中Snail2、IMP3和Wif-1的影响不大(P>0.05),III/IV分期、出现淋巴转移和远端转移的患者的AEG组织中Snail2、IMP3水平显著增高(P<0.05)。III/IV分期、出现淋巴转移和远端转移的患者的AEG组织中Wif-1水平显著降低(P<0.05)。结论:Snail2和IMP3在AEG中过表达,而Wif-1低表达,并且高水平的Snail2、IMP3和低水平的Wif-1与AEG的恶性特征有关,可作为预测AEG转移、预后和复发的生物标志因子。展开更多
Carcinoma of the gastroesophageal junction(GEJ) is defined as carcinoma that crosses the GEJ line,irrespective of where the tumor epicenter is located.This group of cancer is rare but controversial.Based on study resu...Carcinoma of the gastroesophageal junction(GEJ) is defined as carcinoma that crosses the GEJ line,irrespective of where the tumor epicenter is located.This group of cancer is rare but controversial.Based on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries,this cancer is believed to arise from Barrett's esophagus(BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology,clinicopathology,and molecular pathobiology in relation to BE.As such,the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma(EA).This mandate has been challenged recently by the data from several studies carried out mainly in Chinese patients.The emerging evidence derivedfrom those studies suggests:(1) both BE and EA are uncommon in the Chinese population;(2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer,not those of EA;(3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients' prognosis effectively;and(4) prognostic factors of GEJ cancer in Chinese are similar,but not identical,to those of EA.In conclusion,the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from EA.Further investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.展开更多
文摘目的本研究旨在比较近端胃切除术(proximal gastrectomy,PG)与全胃切除术(total gastrectomy,TG)对Siewert Ⅱ型食管胃交界处腺癌(Adenocarcinoma of the esophagogastric junction,AEG)的手术治疗效果,探讨PG在AEG治疗中的可行性与安全性。方法本研究主要纳入了2016年02月至2020年06月于我院接受手术治疗的104例Siewert Ⅱ型AEG患者,根据手术方式的选择,将所有患者分为PG组(n=62)和TG组(n=42),比较两组患者的手术质量,围手术期结局与长期肿瘤学结果。结果两组患者在基线特征分布方面无显著差异,具有可比性(P>0.05)。两种手术方式在手术时间、术中失血量和术后并发症(Clavien-Dindo≥Ⅱ级)等方面无明显差异(P>0.05)。然而,与TG组相比,PG组患者住院时间更短(12[IQR:11,15]vs 15[IQR:14,19]天;t=-1.990,P=0.047),术后6、12个月的体重(6个月:47.8±5.9 vs 50.9±9.2 kg;t=2.090,P=0.039;12个月:46.4±6.4 vs 50.0±9.1 kg;t=2.367,P=0.020)、血清白蛋白(6个月:37.9±4.2 vs 39.3±4.6 g/L,t=2.257,P=0.026;12个月:37.4±3.5 g/L vs 38.9±3.2;t=2.296,P=0.024)及术后12个月的血红蛋白值更低(11.1±2.1 vs 12.2±1.5 g/dL;t=2.688,P=0.008),差异有统计学意义。生存分析表明PG组和TG组患者的3年无复发生存率分别为58.2%和67.4%,差异无统计学意义(χ^(2)=0.669,P=0.414)。结论与TG相比,PG在术后恢复及营养状况方面更有优势,而肿瘤学结果具有可比性。PG或许是治疗Siewert Ⅱ型食管胃交界处腺癌一种可选择的手术方式。
文摘食管胃交界处腺癌(adenocarcinoma of esophagogastric junction,EGJA)有其独特的解剖学位置,同时又位于鳞状上皮与柱状上皮交界之处,其生物学特性不同于食管癌和胃癌,诊断分型一直存在众多的争议,治疗模式在学术界也始终没有公认的"金标准",特别是局部进展期EGJA的治疗策略更是难以抉择。随着影像学技术的发展和各项大型临床研究结果的公布,EGJA的治疗日益个体化,同时也凸显了多学科协作的重要性。本文将针对以上问题对EGJA的最近进展做一综述。
文摘目的:探究Snail2、胰岛素样生长因子II mRNA结合蛋白3(insulin-like growth factor II mRNA-binding protein 3,IMP3)和Wnt通路抑制因子1(Wnt inhibitory factor-1,Wif-1)在食管胃交界处的腺癌(adenocarcinoma of the esophagogastric junction,AEG)中的表达特点及临床意义。方法:随机选择2017年3月至2019年3月间的AEG患者90例作为AEG组,收集同期正常胃组织50例作为健康组。患者经过手术或全身PET-CT检测AEG转移情况。通过免疫组化染色和Western blot检测组织中Snail2、Wif-1、IMP3的表达情况。结果:免疫组化研究结果显示Snail2主要表达于细胞核和细胞质,IMP3主要表达于细胞质,AEG组中Snail2和IMP3的表达水平显著升高。Wif-1在健康组中呈阳性表达,但是在AEG组中表达水平降低。性别、年龄以及肿瘤大小对AEG组织中Snail2、IMP3和Wif-1的影响不大(P>0.05),III/IV分期、出现淋巴转移和远端转移的患者的AEG组织中Snail2、IMP3水平显著增高(P<0.05)。III/IV分期、出现淋巴转移和远端转移的患者的AEG组织中Wif-1水平显著降低(P<0.05)。结论:Snail2和IMP3在AEG中过表达,而Wif-1低表达,并且高水平的Snail2、IMP3和低水平的Wif-1与AEG的恶性特征有关,可作为预测AEG转移、预后和复发的生物标志因子。
基金Supported by Science and Technology Development Project of the Nanjing City in China,No. ZKX05013,No. ZKX07011a special grant from the Nanjing Drum Tower Hospital in Nan-jing,China
文摘Carcinoma of the gastroesophageal junction(GEJ) is defined as carcinoma that crosses the GEJ line,irrespective of where the tumor epicenter is located.This group of cancer is rare but controversial.Based on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries,this cancer is believed to arise from Barrett's esophagus(BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology,clinicopathology,and molecular pathobiology in relation to BE.As such,the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma(EA).This mandate has been challenged recently by the data from several studies carried out mainly in Chinese patients.The emerging evidence derivedfrom those studies suggests:(1) both BE and EA are uncommon in the Chinese population;(2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer,not those of EA;(3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients' prognosis effectively;and(4) prognostic factors of GEJ cancer in Chinese are similar,but not identical,to those of EA.In conclusion,the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from EA.Further investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.
