2194 例胃食管结合部腺癌与胃癌的显著差异：纪念 Rebecca A. Carr，1988 年 2 月 24 日-2021 年 1 月 19 日。

Distinct Differences in Gastroesophageal Junction and Gastric Adenocarcinoma in 2194 Patients: In Memory of Rebecca A. Carr, February 24, 1988-January 19, 2021.

机构信息

Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Thoracic Service, Department of Surgery, Memorial Sloan Kettering cancer center, New York, NY.

出版信息

Ann Surg. 2023 Apr 1;277(4):629-636. doi: 10.1097/SLA.0000000000005320. Epub 2021 Nov 29.

DOI:10.1097/SLA.0000000000005320

PMID:34845172

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9148370/

Abstract

OBJECTIVE

We sought to compare gastroesophageal junction (GEJ) cancer and gastric cancer (GC) and identify clinicopathological and oncological differences.

SUMMARY BACKGROUND DATA

GEJ cancer and GC are frequently studied together. Although the treatment approach for each often differs, clinico-pathological and oncological differences between the 2 have not been fully evaluated.

METHODS

We retrospectively identified patients with GEJ cancer or GC who underwent R0 resection at our center between January 2000 and December 2016. Clinicopathological characteristics, disease-specific survival (DSS), and site of first recurrence were compared.

RESULTS

In total, 2194 patients were analyzed: 1060 (48.3%) with GEJ cancer and 1134 (51.7%) with GC. Patients with GEJ cancer were younger (64 vs 66 years; P < 0.001), more often received neoadjuvant treatment (70.9% vs 30.2%; P < 0.001), and had lower pathological T and N status. Five-year DSS was 62.2% in patients with GEJ cancer and 74.6% in patients with GC ( P < 0.001). After adjustment for clinicopathological factors, DSS remained worse in patients with GEJ cancer (hazard ratio, 1.78; 95% confidence interval, 1.40-2.26; P < 0.001). The cumulative incidence of recurrence was approximately 10% higher in patients with GEJ cancer ( P < 0.001). The site of first recurrence was more likely to be hematogenous in patients with GEJ cancer (60.1% vs 31.4%; P < 0.001) and peritoneal in patients with GC (52.9% vs 12.5%; P < 0.001).

CONCLUSIONS

GEJ adenocarcinoma is more aggressive, with a higher incidence of recurrence and worse DSS, compared with gastric adenocarcinoma. Distinct differences between GEJ cancer and GC, especially in patterns of recurrence, may affect evaluation of optimal treatment strategies.

摘要

目的

我们旨在比较胃食管交界处（GEJ）癌和胃癌（GC），并确定其临床病理和肿瘤学差异。

背景资料概要

GEJ 癌和 GC 常被一起研究。尽管这两种疾病的治疗方法通常不同，但两者之间的临床病理和肿瘤学差异尚未得到充分评估。

方法

我们回顾性地确定了 2000 年 1 月至 2016 年 12 月期间在我们中心接受 R0 切除术的 GEJ 癌或 GC 患者。比较了临床病理特征、疾病特异性生存率（DSS）和首次复发部位。

结果

共分析了 2194 例患者：1060 例（48.3%）为 GEJ 癌，1134 例（51.7%）为 GC。GEJ 癌患者年龄较轻（64 岁 vs 66 岁；P<0.001），更多地接受新辅助治疗（70.9% vs 30.2%；P<0.001），且病理 T 和 N 分期较低。GEJ 癌患者的 5 年 DSS 为 62.2%，GC 患者为 74.6%（P<0.001）。调整临床病理因素后，GEJ 癌患者的 DSS 仍较差（风险比，1.78；95%置信区间，1.40-2.26；P<0.001）。GEJ 癌患者的复发累积发生率高出约 10%（P<0.001）。GEJ 癌患者首次复发的部位更可能是血行转移（60.1% vs 31.4%；P<0.001），GC 患者更可能是腹膜转移（52.9% vs 12.5%；P<0.001）。