近日在線出版的《外科腫瘤學(xué)年鑒》(Annalsof Surgical Oncology)雜志上，發(fā)表了日本神奈川癌癥中心Shinichi Hasegawa博士等人的一項(xiàng)研究結(jié)果，該研究對(duì)食管癌TNM分期標(biāo)準(zhǔn)還是胃癌TNM分期標(biāo)準(zhǔn)更適用于II/III型食管胃結(jié)合部腺癌(AEG)患者分級(jí)進(jìn)行了闡明。這項(xiàng)研究結(jié)果發(fā)現(xiàn)，與食管癌TNM分期標(biāo)準(zhǔn)相比，胃癌TNM分期標(biāo)準(zhǔn)更適用于II/III型食管胃結(jié)合部腺癌(AEG)患者分級(jí)。該研究結(jié)果可能會(huì)對(duì)下一版食管胃結(jié)合部腺癌(AEG)患者TNM分級(jí)方法修訂產(chǎn)生影響。

　　該項(xiàng)研究入選患者為II/III型食管胃結(jié)合部腺癌患者，并且這些患者曾接受D1或根治性更為徹底的巴結(jié)切除術(shù)治療。研究人員按照第七版食管癌TNM分期標(biāo)準(zhǔn)及胃癌TNM分期標(biāo)準(zhǔn)，對(duì)這些患者進(jìn)行分期。該研究還對(duì)患者分布情況、各期風(fēng)險(xiǎn)比(HR)以及患者生存率離散情況進(jìn)行了對(duì)比。

　　該項(xiàng)研究共招募了163例患者。根據(jù)食管癌TNM分期標(biāo)準(zhǔn)及胃癌TNM分期標(biāo)準(zhǔn)，共分別有25例患者(20例與5例)以及32例患者(20例與12例)被認(rèn)定為I期(IA與IB，15例患者(4例與11例)以及33例患者(11例與22例)被認(rèn)定為II期(IIA與IIB，88例患者(24例, 3例與61例) 以及63例患者(14例, 26例與23例) 被認(rèn)定為III期 (IIIA, III B與IIIC)，還有35例與35例患者被認(rèn)定為IV期。研究人員發(fā)現(xiàn)，根據(jù)食管癌TNM分期標(biāo)準(zhǔn)，患者分布在IIIC期出現(xiàn)了大幅偏離，但根據(jù)胃癌TNM分期標(biāo)準(zhǔn)，患者分布則幾乎保持均勻。研究還發(fā)現(xiàn)，根據(jù)胃TNM分期標(biāo)準(zhǔn)，HR呈逐步增加趨勢(shì)，但未發(fā)現(xiàn)食管癌TNM分期標(biāo)準(zhǔn)存在該趨勢(shì)。根據(jù)胃TNM分期標(biāo)準(zhǔn)，II期與III期患者生存率曲線出現(xiàn)明顯離散(P = 0.019)，而根據(jù)食管癌TNM分期標(biāo)準(zhǔn)則不存在該現(xiàn)象(P = 0.204)。根據(jù)食管癌TNM分期標(biāo)準(zhǔn)，IIIA, IIIB以及IIIC期患者的5年生存率分別為69.0, 100以及38.9 %，而根據(jù)胃癌TNM分期標(biāo)準(zhǔn)，則分別為52.0, 43.4 以及33.9 %。

　　Esophagus or Stomach? The Seventh TNM Classification for Siewert Type II/III Junctional Adenocarcinoma

　　Shinichi Hasegawa MD, Takaki Yoshikawa MD, PhD, Toru Aoyama MD, Tsutomu Hayashi MD, Takanobu Yamada MD, Kazuhito Tsuchida MD, Haruhiko Cho MD, Takashi Oshima MD, PhD, Norio Yukawa MD, Yasushi Rino MD, Munetaka Masuda MD, PhD, Akira Tsuburaya MD

　　Background The aim of this study is to clarify whether TNM-EC or TNM-GC is better for classifying patients with AEG types II/III. Methods The patients who had AEG types II/III and received D1 or more radical lymphadenectomy were selected. The patients were staged both by seventh edition of TNM-EC and TNM-GC. The distribution of the patients, the hazard ratio (HR) of each stage, and the separation of the survival were compared. Results A total of 163 patients were enrolled in this study. TNM-EC and TNM-GC classified 25 (20 and 5) and 32 (20 and 12) patients to stage I (IA and IB), 15 (4 and 11), and 33 (11 and 22) to stage II (IIA and IIB), 88 (24, 3, and 61) and 63 (14, 26, and 23) to stage III (IIIA, IIIB, and IIIC), and 35 and 35 to stage IV, respectively. The distribution of the patients was substantially deviated to stage IIIC in TNM-EC but was almost even in TNM-GC. A stepwise increase of HR was observed in TNM-GC, but not in TNM-EC. The survival curves between stages II and III were significantly separated in TNM-GC (P = 0.019), but not in TNM-EC (P = 0.204). The 5-year survival rates of stages IIIA, IIIB, and IIIC were 69.0, 100, and 38.9 % in TNM-EC and were 52.0, 43.4, and 33.9 % in TNM-GC, respectively. Conclusions TNM-GC is better for classifying patients with AEG types II/III than TNM-EC is. These results could impact the next TNM revision for AEG.

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