Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Xi-Cheng District, Beijing, China.
Medicine (Baltimore). 2024 Mar 1;103(9):e37289. doi: 10.1097/MD.0000000000037289.
Adenocarcinoma of the esophagogastric junction (AEG) has a high incidence, and the extent of lymph node dissection (LND) and its impact on prognosis remain controversial. This study aimed to explore the risk factors for lymph node metastasis (LNM) and prognosis in Siewert II/III AEG patients. A retrospective review of 239 Siewert II/III AEG patients surgically treated at Beijing Friendship Hospital from July 2013 to December 2022 was conducted. Preoperative staging was conducted via endoscopy, ultrasound gastroscopy, CT, and biopsy. Depending on the stage, patients received radical gastrectomy with LND and chemotherapy. Clinicopathological data were collected, and survival was monitored semiannually until November 2023. Utilizing logistic regression for data analysis and Cox regression for survival studies, multivariate analysis identified infiltration depth (OR = 0.038, 95% CI: 0.011-0.139, P < .001), tumor deposit (OR = 0.101, 95% CI: 0.011-0.904, P = .040), and intravascular cancer embolus (OR = 0.234, 95% CI: 0.108-0.507, P < .001) as independent predictors of LNM. Lymph nodes No. 1, 2, 3, 4, 7, 10, and 11 were more prone to metastasis in the abdominal cavity. Notably, Siewert III AEG patients showed a higher metastatic rate in nodes No. 5 and No. 6 compared to Siewert II. Mediastinal LNM was predominantly found in nodes No. 110 and No. 111 for Siewert II AEG, with rates of 5.45% and 3.64%, respectively. A 3-year survival analysis underscored LNM as a significant prognostic factor (P = .001). Siewert II AEG patients should undergo removal of both celiac and mediastinal lymph nodes, specifically nodes No. 1, 2, 3, 4, 7, 10, 11, 110, and 111. Dissection of nodes No. 5 and No. 6 is not indicated for these patients. In contrast, Siewert III AEG patients do not require mediastinal LND, but pyloric lymphadenectomy for nodes No. 5 and No. 6 is essential. The presence of LNM is associated with poorer long-term prognosis. Perioperative chemotherapy may offer a survival advantage for AEG patients.
胃食管结合部腺癌（AEG）发病率高，淋巴结清扫范围（LND）及其对预后的影响仍存在争议。本研究旨在探讨 Siewert II/III 型 AEG 患者淋巴结转移（LNM）的危险因素及预后。对 2013 年 7 月至 2022 年 12 月在北京友谊医院接受手术治疗的 239 例 Siewert II/III 型 AEG 患者进行回顾性分析。术前通过内镜、超声胃镜、CT 和活检进行分期。根据分期，患者接受根治性胃切除术和 LND 以及化疗。收集临床病理数据，每半年监测一次生存情况，直至 2023 年 11 月。数据分析采用 logistic 回归，生存研究采用 Cox 回归，多因素分析发现浸润深度（OR=0.038，95%CI：0.011-0.139，P<0.001）、肿瘤沉积（OR=0.101，95%CI：0.011-0.904，P=0.040）和脉管内癌栓（OR=0.234，95%CI：0.108-0.507，P<0.001）是 LNM 的独立预测因素。腹腔内淋巴结 No.1、2、3、4、7、10 和 11 更易发生转移。值得注意的是，Siewert III 型 AEG 患者的淋巴结 No.5 和 No.6 转移率高于 Siewert II 型。Siewert II AEG 的纵隔淋巴结转移主要发生在淋巴结 No.110 和 No.111，转移率分别为 5.45%和 3.64%。3 年生存分析表明，LNM 是一个显著的预后因素（P=0.001）。Siewert II AEG 患者应行腹腔和纵隔淋巴结清扫，包括淋巴结 No.1、2、3、4、7、10、11、110 和 111。对于这些患者，不建议清扫淋巴结 No.5 和 No.6。相比之下，Siewert III AEG 患者不需要纵隔 LND，但需要进行幽门淋巴结清扫，包括淋巴结 No.5 和 No.6。存在 LNM 与较差的长期预后相关。围手术期化疗可能为 AEG 患者带来生存优势。
