Piessen G, Messager M, Lefevre J H, Goéré D, Mabrut J-Y, Meunier B, Brigand C, Hamy A, Glehen O, Mariette C
Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Lille, France; University of Lille - Nord de France, France; Inserm UMR 837, Jean Pierre Aubert Research Center, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis", Lille, France.
Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Lille, France; University of Lille - Nord de France, France; Inserm UMR 837, Jean Pierre Aubert Research Center, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis", Lille, France.
Eur J Surg Oncol. 2014 Dec;40(12):1746-55. doi: 10.1016/j.ejso.2014.04.019. Epub 2014 Jun 26.
The incidence of oesogastric (OG) signet ring cell adenocarcinoma (SRC) is increasing in Western countries. The differential characteristics between oesophageal and gastric SRC tumours are unknown. We aimed to investigate the role of tumour location on prognosis in OG SRC.
Among 924 OG SRC resected in 21 centres from 1997 to 2010, consecutive patients who had oesophageal tumours (group OESO, n = 136) were matched to randomly selected patients who had gastric tumours (group GASTRIC, n = 363). Matching variables were gender, age, American Society of Anaesthesiologists score, malnutrition, pretherapeutic clinical TNM stage and neoadjuvant treatment. Patients and tumour characteristics were compared between groups and prognostic factors were identified.
The two groups were well matched. Tumours in group GASTRIC were more advanced at surgical exploration, with higher rates of linitis plastica (P < 0.001), peritoneal carcinomatosis (P = 0.001), and advanced pTNM stages (P = 0.034). Radicality of resection and recurrence rates were similar (P > 0.480). Recurrences were more frequently distant (P < 0.001) and peritoneal (P < 0.001) in group GASTRIC. After adjustment on confounding variables, gastric location (P = 0.034) was independently associated with a better prognosis than oesophageal location.
Gastric and oesophageal SRC tumours are distinct diseases. Despite similar pretherapeutic factors, gastric tumours were more advanced with a greater propensity for the peritoneal surface at the diagnosis and recurrence and associated with a better prognosis.
在西方国家，食管胃（OG）印戒细胞腺癌（SRC）的发病率正在上升。食管和胃SRC肿瘤之间的差异特征尚不清楚。我们旨在研究肿瘤位置对OG SRC预后的作用。
在1997年至2010年期间于21个中心切除的924例OG SRC中，将连续的食管肿瘤患者（OESO组，n = 136）与随机选择的胃肿瘤患者（GASTRIC组，n = 363）进行匹配。匹配变量包括性别、年龄、美国麻醉医师协会评分、营养不良、治疗前临床TNM分期和新辅助治疗。比较两组患者和肿瘤特征，并确定预后因素。
两组匹配良好。GASTRIC组的肿瘤在手术探查时更晚期，皮革胃（P < 0.001）、腹膜转移（P = 0.001）和晚期pTNM分期（P = 0.034）的发生率更高。切除的根治性和复发率相似（P > 0.480）。GASTRIC组的复发更常见于远处转移（P < 0.001）和腹膜转移（P < 0.001）。在对混杂变量进行调整后，胃部位（P = 0.034）与比食管部位更好的预后独立相关。
胃和食管SRC肿瘤是不同的疾病。尽管治疗前因素相似，但胃肿瘤在诊断和复发时更晚期，更倾向于腹膜表面转移，且与更好的预后相关。
