School of Medicine, University of Sydney, Sydney, New South Wales, Australia.
School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.
ANZ J Surg. 2022 Sep;92(9):2137-2142. doi: 10.1111/ans.17828. Epub 2022 May 30.
The incidence of adenocarcinoma of the distal oesophagus (DO) and gastro-oesophageal junction (GOJ) are increasing. They may represent differing disease processes. This study aimed to assess clinicopathological and survival differences between patients with DO and GOJ adenocarcinomas.
Data were extracted from a prospective single-surgeon database of consecutive patients undergoing an open Ivor-Lewis oesophagectomy for oesophageal adenocarcinoma (distal oesophagus, Siewert type I and II). Differences in clinicopathological characteristics and survival were evaluated and prognostic factors examined using univariate and multivariate survival analyses.
The data were available for 234 patients who underwent an oesophagectomy between 1992 and 2019. DO tumours had higher rates of Barrett's oesophagus (P < 0.001), presented with lower tumour stage (P = 0.02) and were more likely to be associated with fewer lymph nodes resected (P = 0.003) than GOJ tumours. The median overall survival for distal oesophageal tumours was 29.2 months, while gastro-oesophageal tumours was 38.6 months. Kaplan Meier analysis did not show a difference in overall survival between the two groups (P = 0.08). However, when adjusted for potential confounders, GOJ tumours were associated with a reduced adjusted hazard of death (adjusted HR 0.58, 95% CI 0.36-0.92, P = 0.022) compared with DO tumours.
This study suggests that GOJ cancers have different clinicopathological characteristics and improved survival compared to DO tumours.
远端食管（DO）和胃食管交界处（GOJ）腺癌的发病率正在上升。它们可能代表不同的疾病过程。本研究旨在评估 DO 和 GOJ 腺癌患者的临床病理和生存差异。
从一位外科医生的连续食管腺癌（远端食管，Siewert Ⅰ型和Ⅱ型）开放性 Ivor-Lewis 食管切除术的前瞻性单外科医生数据库中提取数据。评估临床病理特征和生存差异，并使用单变量和多变量生存分析检查预后因素。
1992 年至 2019 年期间，共有 234 例患者接受了食管切除术，这些数据可用于研究。DO 肿瘤的 Barrett 食管发生率更高（P<0.001），肿瘤分期较低（P=0.02），并且切除的淋巴结数量较少（P=0.003）的可能性较大。远端食管肿瘤的中位总生存期为 29.2 个月，而胃食管肿瘤为 38.6 个月。Kaplan-Meier 分析显示两组总生存期无差异（P=0.08）。然而，当调整潜在混杂因素后，与 DO 肿瘤相比，GOJ 肿瘤与死亡调整后风险降低相关（调整后的 HR 0.58，95%CI 0.36-0.92，P=0.022）。
本研究表明，与 DO 肿瘤相比，GOJ 癌症具有不同的临床病理特征和改善的生存。
