Liu Kai, Yang Kun, Zhang Weihan, Chen Xiaolong, Chen Xinzu, Zhang Bo, Chen Zhixin, Chen Jiaping, Zhao Yongfan, Zhou Zongguang, Chen Longqi, Hu Jiankun
*Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China †Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Ann Surg. 2016 Jan;263(1):88-95. doi: 10.1097/SLA.0000000000001148.
To evaluate the changes of esophagogastric junctional adenocarcinoma (EGJA) and gastroesophageal reflux disease (GERD) among surgical patients from 1988 to 2012 in a Chinese high-volume hospital.
The incidence of EGJA in Western countries has rapidly increased in recent decades. However, recent data from China remain sparse.
A retrospective analysis was performed on the basis of 5053 patients who underwent surgery for gastric and distal esophageal adenocarcinoma. Total of 1723 patients with EGJA who underwent surgery were included. Changes of the prevalence of GERD and the clinicopathological features and surgical treatment of EGJA were longitudinally analyzed by a 5-year interval.
The proportion of EGJA was increased from 22.3% in period 1 (1988-1992) to 35.7% in period 5 (2008-2012) (P < 0.001). The proportion of Siewert type III (35.9% vs 47.0%) (P < 0.001) and type I (8.7% vs 15.8%) (P = 0.002) tumors of EGJA was also increased during the past 25 years. The prevalence of GERD had increased gradually from 6.5% in period 1 to 10.9% in period 5 for the 3 subgroups without significant difference (P = 0.459). There was an upward tendency with significant difference between the proportion of EGJA and the prevalence of GERD (r = 0.946, P = 0.000). Instead of type II and type III tumors, there was a positive correlation with change in GERD for type I tumors (r = 0.438, P = 0.029). Total gastrectomy was more preferred among patients with EGJA in period 5 than in period 1 (42.0% vs 19.6%) (P < 0.001).
An increasing trend of EGJA is observed during the past 25 years in West China Hospital. The prevalence of GERD among EGJA had showed a gradually increased trend. However, the causality between GERD and EGJA still needs to be researched further. Total gastrectomy is becoming more preferred procedure in patients with EGJA.
评估1988年至2012年期间，中国一家大型医院手术患者中食管胃交界腺癌（EGJA）和胃食管反流病（GERD）的变化情况。
近几十年来，西方国家EGJA的发病率迅速上升。然而，中国的最新数据仍然稀少。
对5053例行胃及远端食管腺癌手术的患者进行回顾性分析。纳入1723例行手术的EGJA患者。以5年为间隔纵向分析GERD患病率的变化以及EGJA的临床病理特征和手术治疗情况。
EGJA的比例从第1阶段（1988 - 1992年）的22.3%增加到第5阶段（2008 - 2012年）的35.7%（P < 0.001）。在过去25年中，EGJA的Siewert III型肿瘤比例（35.9%对47.0%）（P < 0.001）和I型肿瘤比例（8.7%对15.8%）（P = 0.002）也有所增加。3个亚组的GERD患病率从第1阶段的6.5%逐渐增加到第5阶段的10.9%，差异无统计学意义（P = 0.459）。EGJA比例与GERD患病率之间呈上升趋势且差异有统计学意义（r = 0.946，P = 0.000）。与II型和III型肿瘤不同，I型肿瘤与GERD变化呈正相关（r = 0.438，P = 0.029）。与第1阶段相比，第5阶段EGJA患者中全胃切除术的选择更为普遍（42.0%对19.6%）（P < 0.001）。
在华西医院，过去25年中观察到EGJA呈上升趋势。EGJA患者中GERD的患病率呈逐渐上升趋势。然而，GERD与EGJA之间的因果关系仍需进一步研究。全胃切除术在EGJA患者中越来越成为首选术式。
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