胡春华 1李冬冬 1徐义军 1项洪刚 1陈磊 1张文杰1
作者信息
- 1. 上海交通大学医学院附属新华医院普通外科,上海 200092
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摘要
Abstract
Objective:To analyze the clinicopathological factors affecting the prognosis of patients with Siewert typeⅡ/Ⅲ adenocarcinoma of esophagogastric junction (AEG), and the effect of different surgical methods on the quality of life.Methods:The clinical records of patients who were diagnosed with SiewertⅡ/Ⅲ AEG and received surgery from 2004 to 2015 were retrospectively analyzed.The patients followed up for at least 2 years were selected to perform survival analysis.The relationship between clinical pathological factors and prognosis of patients with Siewert Ⅱ/Ⅲ AEG was compared.The status of health-related quality of life at least 1 year after proximal gastrectomy (PG) or total gastrectomy (TG) was evaluated by a questionnaire.Results:A total of 325 patients with AEG were enrolled, including 157 patients with typeⅡAEG (48.3%) and 168 with type Ⅲ AEG (51.7%).The patients with type Ⅲ AEG were likely to have larger tumors, lower differentiation, more lymph node metastasis, and poorer prognosis (all P<0.05).The univariate analysis showed that tumor size, differentiation degree, tumor location, resection range, R0 resection, vessel and nerve invasive status, and TNM stage were the long-term prognostic factors in 284 patients who were followed up for at least 2 years.Correlation analysis showed that the positive rate of lymph node metastasis was negatively correlated with overall survival time (r=-0.520, P<0.001).In patients with typeⅡAEG, there was no significant difference in the 5-year survival rate and survival time between the PG group and the TG group (P>0.05).In patients with type Ⅲ AEG, the 5 year survival rate of the TG group was significantly lower than that of the PG group (P<0.05).The multivariate analysis indicated that T/N stage was an independent prognostic risk factor in typeⅡAEG patients, while TNM stage was an independent prognostic factor in type Ⅲ AEG patients.Multivariate prognostic analysis revealed that T/N stage was a risk factor for prognosis in patients with type Ⅱ AEG, while TNM staging was an independent risk factor for long-term survival in type Ⅲ AEG patients.Moreover, 55 patients completed questionnaires.The survey showed that the patients in the PG group suffered from more serious postoperative reflux as compared with the TG group (P<0.05), but there was no significant difference in other psychical functions and symptoms between the two groups.Conclusions:The patients with type Ⅲ AEG have large tumors, low differentiation, multiple lymph node metastasis and poor prognosis.Therefore, total gastrectomy may be feasible for these patients to ensure R0 resection and thorough cleaning.But for the patients with typeⅡAEG, PG and TG treatment did not affect long-term prognostic survival.关键词
食管胃结合部腺癌/手术治疗/Siewert分型/预后生存/生活质量Key words
adenocarcinoma of esophagogastric junction/surgery/Siewert type/prognostic survival/quality of life分类
医药卫生
