摘要
目的比较食管胃结合部腺癌(AEG)患者与胃窦腺癌患者临床病理特征和预后生存的差异,探讨AEG与胃窦腺癌的预后影响因素。方法收集2001年1月至2012年12月期间,于哈尔滨医科大学附属肿瘤医院进行治疗的239例AEG患者的临床病理资料,同时选取同期313例胃窦腺癌患者的临床资料进行回顾性队列研究。病例入选标准:(1)均接受过根治性手术(R0切除);(2)术后组织标本病理检验证实为AEG或胃窦腺癌;(3)术前均未行新辅助放、化疗;(4)临床病理资料和随访资料完整;(5)排除非肿瘤相关原因死亡的患者。应用独立样本t检验和χ^2检验分析两组患者临床病理特征间的差异,采用Kaplan-Meier法和Log-rank检验对患者的总体生存(OS)进行对比,采用Cox比例风险回归模型对AEG和胃窦癌患者进行多因素预后分析。结果与胃窦腺癌组比,AEG组患者男性比例更高[82.0%(196/239)比65.2%(204/313),χ^2=19.243,P<0.001],年龄偏大[(60±10)岁比(55±12)岁,t=4.895,P<0.001],肿瘤直径偏大[(5.6±2.4)cm比(5.0±3.3)cm,t=2.480,P=0.013],T4期比例更高[64.8%(155/239)比55.6%(174/313),Z=-3.998,P<0.001],以及TNM分期偏晚[Ⅲ期比例:60.7%(145/239)比55.6%(174/313),Z=-2.564,P=0.010]。而两组间血红蛋白和血清白蛋白的差异均无统计学意义(均P>0.05)。AEG患者中位生存期为33.6(3.0~60.0)个月,5年生存率为33.5%;胃窦腺癌患者中位生存期为60.0(3.0~60.0)个月,5年生存率为56.9%;两组差异有统计学意义(P<0.001)。对AEG组患者预后进行单因素分析结果显示,不同血红蛋白检测水平(<130 g/L和≥130 g/L两组5年OS分别为24.0%和39.9%,P=0.006)、肿瘤直径(<5 cm和≥5 cm两组5年OS分别为41.9%和28.8%,P=0.014)、N分期(N0、N1、N2、N3a和N3b期5年OS分别为42.2%、40.9%、31.7%、15.8%和9.0%,P<0.001)和TNM分期(Ⅰ、Ⅱ、Ⅲ期5年OS分别为56.2%、38.5%和28.3%,P=0.017)差异有统计学意义(均P<0.05);而多因素分析结果显示,较差的N分期是AEG患者预后生存的独立危险因素(HR=1.404,95%CI:1.164~1.693,P<0.001),而血红蛋白水平≥130 g/L是AEG患者预后生存的独立保护因素(HR=0.689,95%CI:0.501~0.946,P=0.021)。对胃窦癌组患者预后进行单因素分析显示,血清白蛋白(<40 g/L者和≥40 g/L者5年OS分别为49.1%和61.1%,P=0.021)、肿瘤直径(<5 cm者和≥5 cm者5年OS分别为74.2%和39.9%,P<0.001)、T分期(T1期、T2期、T3期、T4期5年OS分别为98.3%、83.3%、50.0%和36.8%,P<0.001)、N分期(N0期、N1期、N2期、N3a期及N3b期5年OS分别为89.0%、62.3%、50.0%、33.9%和10.3%,P<0.001)和TNM分期(Ⅰ期、Ⅱ期及Ⅲ期5年OS分别为97.3%、75.8%及32.8%,P<0.001)差异有统计学意义(均P<0.05)。而多因素分析结果显示,较差的T分期(HR=1.516,95%CI:1.060~2.167,P=0.023)和N分期(HR=1.453,95%CI:1.209~1.747,P<0.001)是影响胃窦腺癌患者预后生存的独立危险因素。结论与胃窦腺癌比,AEG预后较差,病理分期较晚,原发病灶较大。N分期和血红蛋白水平是影响AEG患者总体生存的独立因素;T分期和N分期是影响胃窦腺癌患者总体生存的独立因素。
Objective To compare the clinicopathological features and the prognosis between patients with adenocarcinoma of esophagogastric junction (AEG) and with adenocarcinoma of gastric antrum (AGA) , and to investigate the prognostic factors of AEG and AGA.Methods A retrospective cohort study was performed on clinicopathological data of 239 AEG patients (AEG group) and 313 AGA patients selected simultaneously (AGA group) undergoing operation at Harbin Medical University Cancer Hospital from January 2001 to December 2012. Inclusion criteria: (1) receiving radical surgery (R0 resection);(2) AEG or AGA confirmed by pathological examination of postoperative tissue specimens;(3) without preoperative neoadjuvant radiotherapy or chemotherapy;(4) complete clinicopathological and follow-up data;(5) patients who died of non-tumor-related causes were excluded. Chi-square test and independent samples t-test were used to determine differences in clinicopathological factors between two groups. The overall survival (OS) of patients was compared by Kaplan-Meier method and Log-rank test. Multivariate prognosis analysis was performed using Cox proportional hazards regression model.Results As compared to AGA group, AEG group had higher proportion of male [82.0% (196/239) vs. 65.2% (204/313) , χ^2=19.243, P<0.001], older age[ (60±10) years vs. (55±12) years, t=4.895, P<0.001], larger tumor diameter[ (5.6±2.4) cm vs. (5.0±3.3) cm, t=2.480, P=0.013], more T4 stage[64.8% (155/239) vs. 55.6% (174/313) , Z=-3.998, P<0.001], and more advanced tumor stage[stage Ⅲ: 60.7% (145/239) vs. 55.6% (174/313) , Z=-2.564, P=0.010]. There were no statistically significant differences in serum albumin or hemoglobin between two groups (all P>0.05) . The 5-year OS rate was 33.5% and 56.9% in AEG group and AGA group respectively and the median OS was 60.0 (3.0-60.0) months and 33.6 (3.0-60.0) months respectively;the difference was statistically significant (P<0.001) . In AEG group, univariate analysis showed that differences of hemoglobin level (5-year OS rate: 24.0% for <130 g/L, 39.9% for ≥130 g/L, P=0.006) , tumor diameter (5-year OS rate: 41.9% for <5 cm, 28.8% for ≥5 cm, P=0.014) , N stage (5-year OS rate: 42.2% for N0, 40.9% for N1, 31.7% for N2, 15.8% for N3a, 9.0% for N3b, P<0.001) and TNM stage (5-year OS rate: 56.2% for stage Ⅰ, 38.5% for stage Ⅱ, 28.3% for stage Ⅲ, P=0.017) were statistically significant (all P<0.05);multivariate analysis revealed that the worse N stage was an independent risk factor of prognosis survival for AEG patients (HR=1.404, 95%CI: 1.164-1.693, P<0.001) , and serum hemoglobin level ≥130 g/L was an independent protective factor of prognosis survival for AEG patients (HR=0.689, 95%CI: 0.501-0.946, P=0.021) . In AGA group, univariate analysis showed that differences of serum albumin (5-year OS rate: 49.1% for <40 g/L, 61.1% for ≥ 40 g/L, P=0.021) , tumor diameter (5-year OS rate: 74.2% for <5 cm, 39.9% for ≥ 5 cm, P<0.001) , T stage (5-year OS rate: 98.3% for T1, 83.3% for T2, 50.0% for T3, 36.8% for T4, P<0.001) , N stage (5-year OS rate: 89.0% for N0, 62.3% for N1, 50.0% for N2, 33.9% for N3a, 10.3% for N3b, P<0.001) and TNM stage (5-year OS rate: 97.3% for stage Ⅰ, 75.8% for stage Ⅱ, 32.8% for stage Ⅲ, P<0.001) were statistically significant (all P<0.05);multivariate analysis revealed that the worse T stage (HR=1.516, 95%CI: 1.060-2.167, P=0.023) and the worse N stage (HR=1.453, 95%CI: 1.209-1.747, P<0.001) were independent risk factors for prognosis of AGA patients.Conclusions As compared to AGA, AEG presents have poorer prognosis, and is easier to present with later pathological stage and larger tumor diameter. N stage and hemoglobin level are independent factors associated with the OS of AEG patients. T stage and N stage are independent factors associated with the OS of AGA patients.
作者
朱子毓
汪亦民
李凤科
高嘉良
韩帮岭
王瑞
薛英威
Zhu Ziyu;Wang Yimin;Li Fengke;Gao Jialiang;Han Bangling;Wang Rui;Xue Yingwei(Department of Gastrointestinal Surgery,Harbin Medical University Cancer Hospital,Harbin 150081,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第2期149-155,共7页
Chinese Journal of Gastrointestinal Surgery
基金
哈尔滨市科技局应用技术研究与开发项目(2017RAXXJ054)
哈尔滨医科大学附属肿瘤医院Nn10资助项目(Nn10PY2017-3).
关键词
食管胃结合部腺癌
胃窦腺癌
临床病理特征
预后
Adenocarcinoma of esophagogastric junction
Adenocarcinoma of gastric antrum
Clinicopathological features
Prognosis
