Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK.
Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Ann Surg Oncol. 2021 Dec;28(13):8485-8494. doi: 10.1245/s10434-021-10346-x. Epub 2021 Jul 13.
Due to a lack of randomized and large studies, the optimal surgical approach for Siewert 2 gastroesophageal junctional (GEJ) adenocarcinoma remains unknown. This population-based cohort study aimed to compare survival between esophagectomy and total gastrectomy for the treatment of Siewert 2 GEJ adenocarcinoma.
Data from the National Cancer Database (NCDB) from 2010 to 2016 was used to identify patients with non-metastatic Siewert 2 GEJ adenocarcinoma who received either esophagectomy (n = 999) or total gastrectomy (n = 8595). Propensity score-matching (PSM) and multivariable analyses were used to account for treatment selection bias.
Comparison of the unmatched cohort's baseline demographics showed that the patients who received esophagectomy were younger, had a lower burden of medical comorbidities, and had fewer clinical positive lymph nodes. The patients in the unmatched cohort who received gastrectomy had a significantly shorter overall survival than those who received esophagectomy (median, 47 vs. 68 months [p < 0.001]; 5-year survival, 45 % vs. 53 %). After matching, gastrectomy was associated with significantly reduced survival compared with esophagectomy (median, 51 vs. 68 months [p < 0.001]; 5-year survival, 47 % vs. 53 %), which remained in the adjusted analyses (hazard ratio [HR], 1.22; 95 % confidence interval [CI], 1.09-1.35; p < 0.001).
In this large-scale population study with propensity-matching to adjust for confounders, esophagectomy was prognostically superior to gastrectomy for the treatment of Siewert 2 GEJ adenocarcinoma despite comparable lymph node harvest, length of stay, and 90-day mortality. Adequately powered randomized controlled trials with robust surgical quality assurance are the next step in evaluating the prognostic outcomes of these surgical strategies for GEJ cancer.
由于缺乏随机对照的大型研究，Siewert 2 胃食管交界腺癌的最佳手术方法仍不清楚。本基于人群的队列研究旨在比较 Siewert 2 胃食管交界腺癌患者接受食管切除术和全胃切除术的生存情况。
本研究使用 2010 年至 2016 年国家癌症数据库（NCDB）的数据，确定接受食管切除术（n = 999）或全胃切除术（n = 8595）治疗的非转移性 Siewert 2 胃食管交界腺癌患者。采用倾向评分匹配（PSM）和多变量分析来校正治疗选择偏倚。
比较未匹配队列的基线人口统计学数据显示，接受食管切除术的患者年龄较小，合并症负担较低，临床阳性淋巴结较少。未匹配队列中接受胃切除术的患者总生存时间明显短于接受食管切除术的患者（中位，47 与 68 个月[P < 0.001]；5 年生存率，45%与 53%）。匹配后，与食管切除术相比，胃切除术的生存时间明显缩短（中位，51 与 68 个月[P < 0.001]；5 年生存率，47%与 53%），调整后的分析结果也如此（风险比[HR]，1.22；95%置信区间[CI]，1.09-1.35；P < 0.001）。
在这项具有倾向评分匹配以调整混杂因素的大规模人群研究中，尽管淋巴结清扫量、住院时间和 90 天死亡率相似，食管切除术在预测预后方面优于胃切除术，可作为治疗 Siewert 2 胃食管交界腺癌的方法。下一步是进行充分的随机对照临床试验，进行严格的手术质量保证，以评估这些胃食管交界腺癌手术策略的预后结果。
