食管胃交界部腺癌SiewertⅠ型和Ⅱ型胸外科手术治疗效果及预后研究

李　飞; 宋　媛; 李　芳; 朱希燕; 何　明

doi:10.19401/j.cnki.1007-3639.2021.02.009

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食管胃交界部腺癌SiewertⅠ型和Ⅱ型胸外科手术治疗效果及预后研究

论著 | 更新时间：2026-01-27

- 食管胃交界部腺癌SiewertⅠ型和Ⅱ型胸外科手术治疗效果及预后研究
- Treatment effect of thoracic surgery for Siewert type Ⅰ and type Ⅱ adenocarcinoma of the esophagogastric junction and prognostic study
- 中国癌症杂志 2021年31卷第2期页码：143-150
- 作者机构：
  
  1. 河北医科大学第四医院胸五科,河北,石家庄,050000
  2. 河北医科大学第四医院检验科,河北,石家庄,050000
  3. 河北医科大学第四医院病理科,河北,石家庄,050000
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2021.02.009
  中图分类号： R735.1;R735.2
- 网络出版：2021-03-02，
  
  纸质出版：2021-03-02
- 稿件说明：
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李　飞, 宋　媛, 李　芳, 朱希燕, 何　明 . 食管胃交界部腺癌SiewertⅠ型和Ⅱ型胸外科手术治疗效果及预后研究[J]. 中国癌症杂志, 2021, 31(2): 143-150.

李　飞, 宋　媛, 李　芳, et al. Treatment effect of thoracic surgery for Siewert type Ⅰ and type Ⅱ adenocarcinoma of the esophagogastric junction and prognostic study[J]. China Oncology, 2021, 31(2): 143-150.
李　飞, 宋　媛, 李　芳, 朱希燕, 何　明 . 食管胃交界部腺癌SiewertⅠ型和Ⅱ型胸外科手术治疗效果及预后研究[J]. 中国癌症杂志, 2021, 31(2): 143-150. DOI： 10.19401/j.cnki.1007-3639.2021.02.009.

李　飞, 宋　媛, 李　芳, et al. Treatment effect of thoracic surgery for Siewert type Ⅰ and type Ⅱ adenocarcinoma of the esophagogastric junction and prognostic study[J]. China Oncology, 2021, 31(2): 143-150. DOI： 10.19401/j.cnki.1007-3639.2021.02.009.

摘要

背景与目的：随着食管癌和胃癌发病率降低，食管胃交界部腺癌（adenocarcinoma of the esophagogastric junction，AEG）发病率近些年呈现缓慢上升的趋势。探讨SiewertⅠ型、Ⅱ型AEG外科治疗方法、淋巴结清扫规律及预后。方法：选取2012年1月—2014年1月在河北医科大学第四医院胸外科同一手术治疗组经手术治疗且术前经电子胃镜检查和术后病理学检查均证实为SiewertⅠ型和Ⅱ型AEG患者共计240例，分为SiewertⅠ型和Ⅱ型两组，生存率的计算采用寿命表法，单因素生存分析采用Kaplan-Meier法分析，组间生存率差异采用log-rank检验，预后因素的多因素生存分析采用Cox回归模型。根据手术方式分为经胸入路组和经胸腹入路组，对两种手术方式采用Kaplan-Meier法进行单因素分析。结果：经胸入路组在手术时间上少于经胸腹入路组，在术后呼吸系统并发症发生率上高于经胸腹入路组；SiewertⅠ型3、5年总生存率分别为36.4%、25.0%；TNM分期、淋巴结分期、淋巴结清扫个数和新辅助化疗患者预后比较，差异有统计学意义（P0.05）。SiewertⅡ型3、5年总生存率分别为41.7%、29.9%；不同TNM分期、淋巴结分期、手术入路和新辅助化疗患者预后比较，差异有统计学意义（P0.05）。Cox比例风险回归模型分析结果显示，TNM分期（HR=3.877，95% CI：0.765~1.979，P=0.019）、淋巴结分期（HR=21.753，95% CI：0.745~1.971，P=0.007）、淋巴结清扫数量（HR=4.113，95% CI：1.511~4.832，P=0.025）和新辅助化疗（HR=6.711，95% CI：1.511~3.977，P=0.041）是影响SiewertⅠ型AEG患者预后的独立因素；TNM分期（HR=6.387，95% CI：0.775~1.932，P=0.031）、淋巴结分期（HR=2.343，95% CI：0.730~2.112，P=0.038）、手术入路（HR=2.991，95% CI：1.592~5.871，P=0.035）、淋巴结清扫数量（HR=3.179，95%CI：1.511~4.832，P=0.032）和新辅助化疗（HR=3.459，95% CI：1.732~4.977，P=0.025）是影响Siewert Ⅱ型AEG患者预后的独立因素。结论：SiewertⅠ型和SiewertⅡ型AEG的治疗应由胸外科完成，病理学分期参考国际抗癌联盟（Union for International Cancer Control，UICC）第8版食管癌分期。经胸入路适合SiewertⅠ型、局限期的患者，经胸腹入路适合SiewertⅡ型、进展期的患者。SiewertⅠ型和SiewertⅡ型AEG手术上切缘的切除范围的安全性和淋巴结转移程度是制约AEG预后的重要因素。对进展期的患者应尽可能地选择术前新辅助化疗。

Abstract

Background and purpose: With the decrease in the incidence of esophageal cancer and gastric cancer

the incidence of adenocarcinoma of the esophagogastric junction (AEG) has shown a slow upward trend in recent years. This study aimed to investigate the surgical treatment for Siewert type Ⅰ and type Ⅱ AEG

lymph node dissection and prognosis. Methods: From Jan 2012 to Jan. 2014

a total of 240 patients with Siewert type Ⅰ and type Ⅱ AEG confirmed by preoperative electronic gastroscopy and postoperative pathology in the same surgical treatment group were selected and divided into Siewert typeⅠgroup and type Ⅱ group. The survival rate was calculated by the life table method and the single factor survival analysis. Kaplan-Meier method was used to analyze the univariate survival rate. Log-rank test was used to analyze the difference in survival rate between the groups. Cox regression model was used for multivariate survival analysis of prognostic factors. According to the operation methods

the patients were divided into transthoracic group and transthoracic abdominal group. Kaplan-Meier method was used for univariate analysis. Results: The 3-year and 5-year overall survival rates of Siewert typeⅠwere 36.4% and 25.0%

respectively. There were significant differences in TNM international stage

lymph node stage

number of lymph node dissection and prognosis of neoadjuvant chemotherapy (P0.05). The 3-year and 5-year overall survival rates of Siewert type Ⅱ were 41.7% and 29.9%

respectively. There were significant differences in the prognosis of patients with different TNM international stages

lymph node stages

surgical approaches and neoadjuvant chemotherapy (P0.05). Cox proportional hazards regression model analysis showed that TNM staging (HR=3.877

95% CI: 0.765-1.949

P=0.019)

lymph node staging (HR=21.753

95% CI: 0.745-1.971

P=0.007)

the number of lymph node dissection (HR=4.113

95% CI: 1.511-4.832

P=0.025) and neoadjuvant chemotherapy (HR=6.711

95% CI: 1.511-3.977

P=0.041) were independent factors affecting the prognosis of patients with Siewert type Ⅰ AEG. TNM staging (HR=6.387

95% CI: 0.775-1.932

P=0.031)

lymph node staging (HR=2.343

95% CI: 0.730-2.112

P=0.038)

surgical approach (HR=2. 991

95% CI: 1. 592-5.871

P=0.035)

lymph node dissection (HR=3.179

95% CI: 1.511-4.832

P=0.032) and neoadjuvant chemotherapy (HR=3.459

95% CI: 1.732-4.977

P=0.025) were independent factors affecting the prognosis of patients with Siewert type Ⅱ AEG. Conclusion: The treatment of Siewert type Ⅰ and type Ⅱ AEG should be completed by thoracic surgery. The pathological staging refers to the Union for International Cancer Control (UICC) 8th edition of esophageal cancer staging. Transthoracic approach is suitable for patients with Siewert type Ⅰ and limited period. The transthoracic abdominal approach is suitable for patients with Siewert type Ⅱ and advanced stage. The safety of the resection range of the upper margin for Siewert type Ⅰ and type Ⅱ AEG surgery and the degree of lymph node metastasis are important factors for the prognosis of AEG. For patients with advanced AEG

neoadjuvant chemotherapy should be used as much as possible.

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