Department of Surgery, St. James's Hospital and Trinity College Dublin, Trinity Center, Dublin 8, Ireland.
World J Surg. 2010 Dec;34(12):2821-9. doi: 10.1007/s00268-010-0783-y.
Adenocarcinoma of the esophagogastric junction (AEG) as described by Siewert et al. is classified as one entity in the latest (7th Edition) American Joint Cancer Committee/International Union Against Cancer (AJCC/UICC) manual, compared with the previous mix of esophageal and gastric staging systems. The origin of AEG tumors, esophageal or gastric, and their biology remain controversial, particularly for AEG type II (cardia) tumors.
We adapted a large prospective database (n = 520: 180 type I, 182 type II, 158 type III) to compare AEG tumors under the new TNM system Pathological variables associated with prognosis were compared (pT, pN, stage, differentiation, R status, lymphovascular invasion, perineural involvement, number of positive nodes, percent of positive nodes, and tumor length), as well as overall survival.
Compared with AEG type I tumors, type II and type III tumors had significantly (p < 0.05) more advanced pN stages, greater number and percentage of positive nodes, poorer differentiation, more radial margin involvement, and more perineural invasion. In AEG type I, 14/180 patients (8%) had >6 involved nodes (pN3), compared with 16 and 30% of patients classified type II and III, respectively. Median survival was significantly (p = 0.03) improved for type I patients (38 months) compared with those with tumors classified as type II (28 months) and type III (24 months). In multivariate analysis node positivity and pN staging but not AEG site had an impact on survival.
In this series AEG type I is associated with more favorable pathologic features and improved outcomes compared with AEG type II and III. This may reflect earlier diagnosis, but an alternative possibility, that type I may be a unique paradigm with more favorable biology, requires further study.
Siewert 等人所描述的食管胃结合部腺癌（AEG）在最新（第 7 版）美国癌症联合委员会/国际抗癌联盟（AJCC/UICC）手册中被归类为一个实体，与之前的食管和胃分期系统混合分类相比有所不同。AEG 肿瘤的起源，食管或胃，以及它们的生物学特性仍然存在争议，特别是对于 AEG Ⅱ型（贲门）肿瘤。
我们改编了一个大型前瞻性数据库（n=520：180 型 I，182 型 II，158 型 III），以比较新 TNM 系统下的 AEG 肿瘤。比较了与预后相关的病理变量（pT、pN、分期、分化、R 状态、淋巴血管侵犯、神经周围侵犯、阳性淋巴结数量、阳性淋巴结百分比和肿瘤长度）以及总生存率。
与 AEG Ⅰ型肿瘤相比，Ⅱ型和Ⅲ型肿瘤的 pN 分期明显更晚（p<0.05），阳性淋巴结数量和百分比更多，分化程度更低，切缘更有放射性，神经周围侵犯更多。在 AEG Ⅰ型中，14/180 例（8%）患者有>6 个受累淋巴结（pN3），而Ⅱ型和Ⅲ型患者分别为 16%和 30%。与被归类为Ⅱ型（28 个月）和Ⅲ型（24 个月）的患者相比，Ⅰ型患者的中位生存期显著提高（p=0.03）（38 个月）。多变量分析显示，淋巴结阳性和 pN 分期而非 AEG 部位对生存有影响。
在本系列中，与 AEG Ⅱ型和Ⅲ型相比，AEG Ⅰ型与更有利的病理特征和更好的预后相关。这可能反映了更早的诊断，但另一种可能性是，Ⅰ型可能是一种具有更有利生物学特性的独特范例，需要进一步研究。
