Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg. 2012 May;255(5):908-15. doi: 10.1097/SLA.0b013e31824beb95.
The aim of this study was to evaluate the adequacy of esophageal classification for adenocarcinoma of the esophagogastric junction (AEJ) of the seventh American Joint Committee on Cancer (AJCC) TNM classification.
The seventh AJCC TNM classification proposed the new classification for AEJ as a part of esophageal cancer depending on the esophagogastric junction (EGJ) involvement. However, there are still many controversies over the classification system for AEJ.
A review of pathologic reports and photographic findings at Seoul National University Hospital from 2003 to 2009 identified 4524 patients with single, primary adenocarcinoma of the EGJ (n = 497) and other regions of the stomach (GC, n = 4027) who underwent an operation with curative intent. We analyzed the clinicopathologic features and postoperative prognosis of AEJ using the Siewert classification and the seventh AJCC TNM classification.
There was no Siewert type I (AEJ I) in this study. The prognosis of AEJ was similar to that of GC. There was no difference in clinicopathologic features between AEJ II and AEJ III. Even though AEJ extending into the EGJ (AEJe) showed more advanced pathologic features than AEJ not extending into the EGJ (AEJg), the prognosis of AEJe and AEJg was not significantly different when stratified by T stage. Compared with the classification of gastric cancer applied for AEJ, esophageal classification for AEJ from the seventh AJCC TNM classification showed a loss of distinctiveness at each TNM stage.
To evaluate the postoperative prognosis of AEJ within the stomach, AEJ II and AEJ III should be considered a part of gastric cancer irrespective of EGJ involvement.
本研究旨在评估第七版美国癌症联合委员会（AJCC）TNM 分期中食管腺癌（AEJ）的食管分类对 AJCC 分期的充分性。
第七版 AJCC TNM 分期将 AEJ 作为食管癌的一部分提出，取决于食管胃结合部（EGJ）的受累情况。然而，AEJ 的分类系统仍存在许多争议。
对 2003 年至 2009 年在首尔国立大学医院进行的手术治疗且具有单一原发性 EGJ 腺癌（n = 497）和胃其他部位腺癌（GC，n = 4027）的病理报告和摄影结果进行回顾性分析。我们使用 Siewert 分类和第七版 AJCC TNM 分类分析 AEJ 的临床病理特征和术后预后。
本研究中没有 Siewert Ⅰ型（AEJ I）。AEJ 的预后与 GC 相似。AEJ II 型和 AEJ III 型的临床病理特征无差异。即使延伸至 EGJ 的 AEJ（AEJe）具有比未延伸至 EGJ 的 AEJ（AEJg）更先进的病理特征，但根据 T 分期分层时，AEJe 和 AEJg 的预后无显著差异。与用于 AEJ 的胃癌分类相比，第七版 AJCC TNM 分类的 AEJ 食管分类在每个 TNM 分期的区分度都有所降低。
为了评估 AEJ 在胃内的术后预后，无论 EGJ 是否受累，AEJ II 型和 AEJ III 型均应被视为胃癌的一部分。
