Saito Hiroaki, Fukumoto Youji, Osaki Tomohiro, Fukuda Kenji, Tatebe Shigeru, Tsujitani Shunichi, Ikeguchi Masahide
Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago 683-8504 Japan.
World J Surg. 2006 Oct;30(10):1864-9. doi: 10.1007/s00268-005-0582-z.
Carcinoma arising in the cardioesophageal junction is a distinct clinical entity compared with tumors located in other regions of the stomach. The prognosis for adenocarcinoma of the upper stomach is considered to be relatively poorer than carcinomas of the more distal stomach. We have therefore investigated patients with carcinoma of the gastric cardia in order to evaluate the underlying cause of this poor prognosis.
Clinicopathologic features and postoperative prognosis of 101 patients with carcinoma of the cardia were evaluated and compared with findings on 1884 patients with tumors in other regions of the stomach.
Tumors of the cardia had a mean size of 6.8 cm, which was significantly larger than the mean size of 5.9 cm for tumors found in the middle- and lower third of the stomach. The incidence of serosal invasion, lymph node metastasis, and lymphatic and blood vessel invasion was higher in association with adenocarcinoma of the cardia than with adenocarcinoma in remaining parts of the stomach. In the analysis of patients who had undergone curative resection, the 5-year survival rates were 61.6, 79.1, and 82.6% in patients with carcinoma of the cardia, upper one-third, and remaining middle- and lower one-third of the stomach, respectively, and the differences were statistically significant. Multivariate analysis indicated that adenocarcinoma of the gastric cardia is an independent prognostic factor. With regard to the site of recurrence, both lymph node and hematogenous recurrence were observed more frequently in the cardia than in the remaining parts of the stomach.
Our data indicate that the prognosis of patients with adenocarcinoma of the gastric cardia is extremely poor. To improve their prognosis, new treatments in addition to gastrectomy with extensive lymph node dissection are needed.
与位于胃其他区域的肿瘤相比，贲门食管交界处发生的癌是一种独特的临床实体。胃上部腺癌的预后被认为相对比胃远端癌的预后更差。因此，我们对贲门癌患者进行了调查，以评估这种不良预后的潜在原因。
对101例贲门癌患者的临床病理特征和术后预后进行评估，并与1884例胃其他区域肿瘤患者的结果进行比较。
贲门肿瘤的平均大小为6.8 cm，明显大于胃中下部发现的肿瘤的平均大小5.9 cm。与贲门腺癌相关的浆膜侵犯、淋巴结转移以及淋巴管和血管侵犯的发生率高于胃其余部分的腺癌。在对接受根治性切除的患者的分析中，贲门癌、胃上三分之一癌以及胃其余中下部癌患者的5年生存率分别为61.6%、79.1%和82.6%，差异具有统计学意义。多因素分析表明，胃贲门腺癌是一个独立的预后因素。关于复发部位，贲门处的淋巴结复发和血行复发均比胃其余部分更常见。
我们的数据表明，胃贲门腺癌患者的预后极差。为改善其预后，除了行广泛淋巴结清扫的胃切除术外，还需要新的治疗方法。
