Portale Giuseppe, Peters Jeffrey H, Hagen Jeffrey A, Demeester Steven R, Gandamihardja Tasha A K, Tharavej Chadin, Hsieh Chih-Cheng, Demeester Tom R
Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA 90033, USA.
Arch Surg. 2005 Jun;140(6):570-4; discussion 574-5. doi: 10.1001/archsurg.140.6.570.
The incidence of adenocarcinoma in the distal esophagus and at the gastroesophageal junction (GEJ) has been increasing in the last decades. It has been suggested that patients in whom Barrett mucosa can be identified in the surgical specimen have a better prognosis compared with those without. This has led to the belief that patients with and without Barrett mucosa may represent 2 distinct cancer types.
Distal esophageal-GEJ adenocarcinoma with and without Barrett mucosa share the same origin, but differ only in clinical presentation and outcome.
Retrospective cohort study in a university tertiary referral center.
Between 1992 and 2002, 215 patients (173 men and 42 women; median age, 66 years; age range, 26-91 years) had esophagogastrectomy for adenocarcinoma of the distal esophagus-GEJ. Patients receiving neoadjuvant chemotherapy or radiation therapy were excluded.
Clinical presentation, tumor characteristics, and survival were compared in patients with Barrett mucosa (n = 140) and those without (n = 75).
Patients with Barrett mucosa in the specimen had tumors that were diagnosed earlier; were smaller in size; earlier in stage, with fewer node metastases; and had a better 5-year survival.
Observed differences in survival between patients with distal esophageal-GEJ adenocarcinoma with and without Barrett mucosa can be explained by earlier diagnosis. Patients without Barrett mucosa have their tumors detected later, when the disease is more advanced. This suggests the possibility that tumors without Barrett mucosa are not of a different origin, but rather are larger tumors that may have overgrown areas of Barrett mucosa.
在过去几十年中，远端食管和胃食管交界（GEJ）处腺癌的发病率一直在上升。有人提出，在手术标本中能够识别出巴雷特黏膜的患者与未识别出的患者相比，预后更好。这导致人们认为有和没有巴雷特黏膜的患者可能代表两种不同的癌症类型。
有和没有巴雷特黏膜的远端食管-GEJ腺癌起源相同，但仅在临床表现和预后方面存在差异。
在一所大学三级转诊中心进行的回顾性队列研究。
1992年至2002年间，215例患者（173例男性和42例女性；中位年龄66岁；年龄范围26 - 91岁）因远端食管-GEJ腺癌接受了食管胃切除术。接受新辅助化疗或放疗的患者被排除。
比较有巴雷特黏膜的患者（n = 140）和没有巴雷特黏膜的患者（n = 75）的临床表现、肿瘤特征和生存率。
标本中有巴雷特黏膜的患者肿瘤诊断较早；肿瘤较小；分期较早，淋巴结转移较少；5年生存率较高。
有和没有巴雷特黏膜的远端食管-GEJ腺癌患者在生存率上的差异可以通过早期诊断来解释。没有巴雷特黏膜的患者在疾病更晚期时才检测到肿瘤。这表明没有巴雷特黏膜的肿瘤可能并非起源不同，而是更大的肿瘤，可能已经生长超过了巴雷特黏膜区域。
