Li Yunzhu, Li Jiayu, Li Jiman
Department of Pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Histol Histopathol. 2021 Mar;36(3):339-346. doi: 10.14670/HH-18-296. Epub 2020 Dec 30.
The incidence of oesophagogastric junction adenocarcinoma has increased rapidly but remains controversial over the last decades. There are two crucial updates of the fifth World Health Organization (WHO) classification, including the alteration of its definition and the emphasis on the human epidermal growth factor receptor 2 (HER2) test.
A total of 566 clinicopathological samples from patients who were diagnosed with gastric adenocarcinoma were retrospectively analyzed. We comprehensively compared the clinicopathological features of oesophagogastric junction adenocarcinoma between the fourth (V4.0) and fifth (V5.0) WHO versions. The clinicalpathological features among oesophagogastric junction, proximal and distal gastric tumors with fourth and fifth edition were also compared, respectively. Also, we discuss the correlation of HER2-expression with clinicopathological features according to the V5.0.
The results showed that the difference was mainly between oesophagogastric junction and distal adenocarcinoma in V4.0, while some were found between proximal and distal adenocarcinoma in V5.0. Tumors invading the oesophagus more than 3cm were still mainly oesophagogastric junction tumors. The expression of HER2 in oesophagogastric junction and proximal gastric adenocarcinoma was still higher than that in gastric body and distal sites.
The clinicopathological parameters of the oesophagogastric junction tumors changed to some extent in the updated WHO version. The proximal gastric tumors tended to be more invasive, more than those located in oesophagogastric junction. But the latter with oesophageal invasion required additional management. The HER2-expression of oesophagogastric junction adenocarcinoma is the highest. The classification of V5.0 is reasonable and worth recommendation.
在过去几十年中，食管胃交界腺癌的发病率迅速上升，但仍存在争议。世界卫生组织（WHO）第五版分类有两项关键更新，包括其定义的改变以及对人表皮生长因子受体2（HER2）检测的强调。
对566例经诊断为胃腺癌患者的临床病理样本进行回顾性分析。我们全面比较了WHO第四版（V4.0）和第五版（V5.0）中食管胃交界腺癌的临床病理特征。还分别比较了第四版和第五版中食管胃交界、近端和远端胃肿瘤的临床病理特征。此外，我们根据V5.0讨论了HER2表达与临床病理特征的相关性。
结果显示，差异在V4.0中主要存在于食管胃交界癌和远端腺癌之间，而在V5.0中则存在于近端和远端腺癌之间。侵犯食管超过3cm的肿瘤仍主要是食管胃交界肿瘤。食管胃交界癌和近端胃癌中HER2的表达仍高于胃体和远端部位。
WHO更新版本中食管胃交界肿瘤的临床病理参数有一定程度的变化。近端胃肿瘤往往比位于食管胃交界的肿瘤更具侵袭性。但后者伴有食管侵犯则需要额外处理。食管胃交界腺癌的HER2表达最高。V5.0分类合理，值得推荐。
