基于中国患者第八版TNM分期系统，肿瘤位置是食管腺癌的独立预后因素。
Tumor location is an independent prognostic factor of esophageal adenocarcinoma based on the eighth edition of TNM staging system in Chinese patients.
作者信息
Deng Han-Yu, Zheng Xi, Alai Guha, Li Gang, Luo Jun, Zhuo Ze-Guo, Lin Yi-Dan
机构信息
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
出版信息
Ann Transl Med. 2019 Aug;7(16):365. doi: 10.21037/atm.2019.01.84.
BACKGROUND
Whether tumor location has any impact on the survival of esophageal adenocarcinoma patients remains unclear. Therefore, we aimed to investigate the prognostic value of tumor location for esophageal adenocarcinoma based on the eighth edition of tumor-node-metastasis (TNM) staging system in Chinese patients for the first time.
METHODS
We conducted a retrospective analysis of patients undergoing esophagectomy for esophageal adenocarcinoma in our department. We analyzed the data about demography, comorbidity, pathologic findings, surgical approach, adjuvant therapy, and survival time. Tumor location was categorized into two groups: adenocarcinomas at the esophagogastric junction (EGJ) and adenocarcinomas at other sites of the esophagus. Both univariate and multivariate analyses were applied. And propensity-score matched (PSM) analysis was also conducted for comparison.
RESULTS
A total of 107 patients from January 2009 to December 2015 were involved in the analysis. The median follow-up time was 60.0 months and the median survival time of all those patients was 41.0 months. In the univariate analysis, adenocarcinomas in the EGJ (P=0.047), early pT stage (P=0.030), and moderate/well differentiation (P=0.022) were significantly correlated with better survival. Moreover, in the multivariate analysis, tumor site [hazard ratio (HR) =0.536; 95% confidence interval (CI) =0.300-0.958], pT stage (HR =0.298; 95% CI =0.124-0.717), and tumor differentiation (HR =0.437; 95% CI =0.238-0.802) were significant independent prognostic factors for overall survival of these esophageal adenocarcinoma patients. After the adjustment by PSM, patients with adenocarcinomas at the EGJ still yielded significantly longer survival than these with adenocarcinomas at other sites of the esophagus (P=0.039).
CONCLUSIONS
Tumor location was an independent prognostic factor for esophageal adenocarcinoma based on the eighth edition of TNM staging system in Chinese patients. Therefore, different surgical therapeutic modalities may be applied for esophageal adenocarcinoma with different tumor locations.
背景
肿瘤位置对食管腺癌患者的生存是否有影响仍不清楚。因此，我们旨在首次基于第八版肿瘤-淋巴结-转移（TNM）分期系统，研究肿瘤位置对中国食管腺癌患者的预后价值。
方法
我们对在我科接受食管切除术的食管腺癌患者进行了回顾性分析。我们分析了有关人口统计学、合并症、病理结果、手术方式、辅助治疗和生存时间的数据。肿瘤位置分为两组：食管胃交界（EGJ）处的腺癌和食管其他部位的腺癌。应用单因素和多因素分析。并且还进行了倾向评分匹配（PSM）分析以作比较。
结果
2009年1月至2015年12月期间共有107例患者参与分析。中位随访时间为60.0个月，所有这些患者的中位生存时间为41.0个月。在单因素分析中，EGJ处的腺癌（P=0.047）、早期pT分期（P=0.030）和中/高分化（P=0.022）与较好的生存显著相关。此外，在多因素分析中，肿瘤部位[风险比（HR）=0.536；95%置信区间（CI）=0.300-0.958]、pT分期（HR =0.298；95%CI =0.124-0.717）和肿瘤分化（HR =0.437；95%CI =0.238-0.802）是这些食管腺癌患者总生存的显著独立预后因素。经PSM调整后，EGJ处腺癌患者的生存时间仍显著长于食管其他部位腺癌患者（P=0.039）。
结论
基于第八版TNM分期系统，肿瘤位置是中国食管腺癌患者的独立预后因素。因此，对于不同肿瘤位置的食管腺癌可采用不同的手术治疗方式。
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