Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
ESMO Open. 2020 Apr;5(2). doi: 10.1136/esmoopen-2019-000595.
Different approaches are used to treat resectable tumours in patients having adenocarcinoma at the oesophagogastrointestinal junction (EGJ) or in the stomach. However, there is limited information about treatment efficacy for patients at metastatic stage. A recent molecular analysis of upper gastrointestinal tract adenocarcinoma revealed that the anatomical location can influence the molecular backgrounds of tumours. This study sought to elucidate whether different therapeutic approaches should be used for EGJ tumours relative to those in the stomach.
This retrospective cohort study was conducted at a single institute in Japan. Patients having metastatic or recurrent adenocarcinoma in the EGJ or stomach who underwent platinum doublet chemotherapy between January 2007 and August 2014 were enrolled. Patients in the EGJ tumour group had tumours having an epicentre within 2 cm proximal or 5 cm distal to the estimated anatomical EGJ and cardia.
Among 378 consecutively enrolled patients, 61 were grouped into the EGJ group and the remainder comprised the stomach group. The EGJ group had more men and lower incidence of diffuse type and Borrmann type IV tumours and peritoneum metastasis compared with the stomach group. The median overall survival of patients in the EGJ and stomach groups was similar (17.3 months (95% CI 13.5 to 23.2) vs 14.5 months (95% CI 13.3 to 16.4)). No statistically significant difference was observed in progression-free survival. Although the overall postprogression survival differed significantly between the EGJ and stomach groups (8.2 months (95% CI 5.7 to 12.7) vs 7.1 months (95% CI 6.1 to 7.8)), on grouping patients by histological type, the two groups exhibited similar postprogression survival. Multivariate analysis demonstrated that diffuse-type histology, higher serum CA19-9 levels and neutrophil to lymphocyte ratios were independent poor prognostic factors.
Different clinicopathological features of EGJ adenocarcinoma were not associated with clinical outcomes of platinum doublet chemotherapy. Histological subtype rather than anatomical location has more significance for treatment decisions for advanced gastric cancers.
对于食管胃结合部（EGJ）或胃腺癌可切除肿瘤患者，采用不同的方法进行治疗。然而，关于转移性阶段患者的治疗效果信息有限。最近对消化道腺癌的分子分析显示，解剖位置会影响肿瘤的分子背景。本研究旨在阐明对于 EGJ 肿瘤，是否应采用与胃肿瘤不同的治疗方法。
这是一项在日本的单机构回顾性队列研究。纳入 2007 年 1 月至 2014 年 8 月期间接受铂类双联化疗的 EGJ 或胃部转移性或复发性腺癌患者。EGJ 肿瘤组的患者肿瘤中心位于 EGJ 近端 2cm 或远端 5cm 内和贲门。
在连续纳入的 378 例患者中，61 例归入 EGJ 组，其余归入胃组。与胃组相比，EGJ 组男性更多，弥漫型和 Borrmann Ⅳ型肿瘤及腹膜转移发生率更低。EGJ 组和胃组患者的中位总生存期相似（17.3 个月（95%CI 13.5 至 23.2）与 14.5 个月（95%CI 13.3 至 16.4））。无进展生存期无统计学差异。尽管 EGJ 组和胃组的总进展后生存存在显著差异（8.2 个月（95%CI 5.7 至 12.7）与 7.1 个月（95%CI 6.1 至 7.8）），但通过组织学类型分组后，两组的进展后生存相似。多变量分析显示，弥漫型组织学、较高的血清 CA19-9 水平和中性粒细胞与淋巴细胞比值是独立的不良预后因素。
EGJ 腺癌的不同临床病理特征与铂类双联化疗的临床结局无关。组织学亚型而不是解剖位置对晚期胃癌的治疗决策具有更重要的意义。
