Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK; Cancer Sciences Unit, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
J Surg Oncol. 2014 Mar;109(3):202-7. doi: 10.1002/jso.23484. Epub 2013 Nov 14.
The Siewert classification has been used to plan treatment for tumours of the gastro-oesophageal junction since its proposal in the 1980s. The purpose of this study was to assess its continued relevance by evaluating whether there were differences in the biology and clinical characteristics of adenocarcinomas by Siewert type, in a contemporary cohort of patients, in whom the majority had received neoadjuvant chemotherapy.
A prospective database was reviewed for all patients who underwent resection from 2005 to 2011 and analysed with regard to Siewert classification determined from the pathological specimen, treatment and clinicopathological outcomes.
Two hundred and sixteen patients underwent oesophagogastric resection: 133 for type I, 51 for type II and 33 for type III tumours. 135 Patients (62.5%) received neoadjuvant chemotherapy with no difference between groups. There were no significant differences in age, sex, pT stage, pN stage, pM stage, ASA, or inpatient complications between patients with adenocarcinoma based on their Siewert classification. There was a significant increase in maximum tumour diameter (P = 0.023), perineural invasion (P = 0.021) and vascular invasion (P = 0.020), associated with more distal tumours (Type III > Type II > Type I). Median overall survival was significantly shorter for more distal tumours (Type I: 4.96 years vs. Type II: 3.3 years vs. Type III: 2.64 years; P = 0.04). The surgical approach did not influence survival.
In the era of multi-modal treatment pathological Siewert tumour type is of prognostic value, as patients with Type III disease are likely to have larger and more aggressive tumours that lead to worse outcomes.
自 20 世纪 80 年代以来，Siewert 分类法一直被用于计划治疗胃食管交界处肿瘤。本研究的目的是通过评估在大多数患者接受新辅助化疗的当代患者队列中，Siewert 型肿瘤的生物学和临床特征是否存在差异，来评估其持续相关性。
回顾性分析了 2005 年至 2011 年间所有接受胃食管切除术的患者的前瞻性数据库，并根据病理标本、治疗和临床病理结果对 Siewert 分类进行了分析。
216 例患者接受了胃食管切除术：133 例为 I 型，51 例为 II 型，33 例为 III 型肿瘤。135 例（62.5%）患者接受了新辅助化疗，各组之间无差异。根据 Siewert 分类，腺癌患者在年龄、性别、pT 分期、pN 分期、pM 分期、ASA 或住院并发症方面无显著差异。肿瘤最大直径（P=0.023）、神经周围侵犯（P=0.021）和血管侵犯（P=0.020）与肿瘤位置更远有关，即 III 型>II 型>I 型。远处肿瘤（I 型：4.96 年；II 型：3.3 年；III 型：2.64 年；P=0.04）的总生存时间明显更短。手术方式对生存无影响。
在多模式治疗时代，病理 Siewert 肿瘤类型具有预后价值，因为 III 型疾病患者的肿瘤可能更大、侵袭性更强，导致预后更差。
