| BackgroundEsophageal cancer is a common malignant tumor in human beings,and its morbidity ranks third and mortality ranks fourth in mainland China.Esophageal cancer in China is mainly esophageal squamous.However,with the increase of gastroesophageal reflux disease(GERD)and Barrett’s esophagus,the incidence of esophageal adenocarcinoma has also increased in China,and more attention has been paid.Esophageal adenocarcinoma is a glandular tubular differentiated malignant epithelial tumor that originates from the Barrett mucosa in the lower esophagus and mainly located in the lower esophagus.It is worth noting that the incidence of adenocarcinoma of esophagogastric junction(AEG)adjacent to the lower esophagus has also increased in recent years.AEG is an adenocarcinoma whose tumor center is located within 5cm above and below the esophagogastric junction(EGJ),and crossing or touching EGJ.There is still much controversy whether it belongs to esophageal cancer,gastric cancer or independent disease.At present,the most widely used classification for AEG is still Siewert classification,which is divided into 3 types according to the distance between the tumor center and EGJ:type I means that tumor center is 1-5 cm above the EGJ;type Ⅱ range in locations from 1 cm above to 2 cm below the EGJ;type Ⅲ means that tumor center is 2-5 cm below the EGJ.According to the 8th edition of American Joint Committee on Cancer(AJCC),the tumor center is located 2 cm below the EGJ(including 2 cm)AEG staging by esophageal adenocarcinoma,that is to say the staging of proximal(Siewert type Ⅰ and type Ⅱ)AEG should follow esophageal adenocarcinoma criteria;while the tumor center is located 2 cm below the EGJ AEG staging by gastric cancer,that is to say the staging of distal(Siewert type Ⅲ)AEG should follow gastric cancer criteria.Previous studies have shown that Barrett’s esophagus is related to AEG,especially closely to proximal(Siewert type Ⅰ and type Ⅱ)AEG,while distal(Siewert type Ⅲ)AEG is mainly related to intestinal metaplasia.Therefore,in order to understand the onset characteristics of lower esophageal adenocarcinoma,Siewert type Ⅰ and type Ⅱ AEG,and the relationship between lower esophageal adenocarcinoma and proximal(Siewert type Ⅰ and type Ⅱ)AEG,this study will retrospectively analyze the cases of lower esophageal adenocarcinoma and proximal(Siewert type Ⅰ and type Ⅱ)AEG from Henan Province,a high incidence area of esophageal cancer,in order to improve the understanding of esophageal adenocarcinoma and AEG.ObjectiveTo analyze the incidence,clinicopathological features and prognosis and of lower esophageal adenocarcinoma,Siewert type Ⅰ and type Ⅱ AEG in,and the relationship between lower esophageal adenocarcinoma and proximal(Siewert type Ⅰand type Ⅱ)AEG,so as to provide a reference for clinical diagnosis and treatment,prognosis assessment and disease prevention.MethodsFrom January 2010 to January 2018,the data of 104 patients with lower esophageal adenocarcinoma,63 patients with Siewert type Ⅰ AEG,and 411 patients with Siewert type Ⅱ AEG were collected,and the clinical characteristics and treatment methods of all patients were retrospectively analyzed.All patients were followed up by telephone and endoscopy to know about their prognosis.It was until June 2018 that follow up work ended,about 6 to 102 months.Analyze differences between groups by χ2 and t test,and explore detection rate trends over time by trendχ2 test.Using Kaplan-Meier method and Log-rank to do survival analysis,and using COX regression model to analyze the prognostic factors.Results1.During the 8 years,the annual detection rate of lower esophageal adenocarcinoma were 0.8‰,1.1‰,1.1‰,1.4‰,1.5‰,1.4‰,1.5‰,1.3‰,the annual detection of Siewert type Ⅰ AEG were 0.2‰,0.3‰ 0.4‰,0.4‰,0.7‰,0.5‰,0.6‰,0.6‰,and the annual detection of Siewert type Ⅱ AEG were 2.3‰,3.2‰,4.7‰,5.4‰、8.7‰,6.5‰,6.3‰,5.2‰,suggesting an increasing incidence trend(P<0.05).2.The median survival time of postoperative patients with lower esophageal adenocarcinoma was 56 months,and the 1-,3-,5-year cumulative survival rates were 88.8%、66.8%、32.1%.The tumor N stage and maximum diameter were independent risk factors for patients[relative ratio(RR)=1.727,2.288,95%confidence interval(CI):1.225-2.434,1.082-4.838,P<0.05].3.There was no significant difference between the cumulative survival rate of the Siewert type Ⅰ and type Ⅱ AEG.The median survival time of patients with Siewert type Ⅰ after surgery was 48 months,and the 1-,3-,5-year cumulative survival rates were 94.6%,63.1 and 31.8%;the median survival time of patients with Siewert typeⅡ after surgery was 46 months,and the 1-,3-,5-year cumulative survival rates were 90.6%,66.1%and 30.1%.We found no significant difference in gender,age,tumor size,degree of differentiation,and TNM stage.Tumor N stage and tumor TNM stage were independent risk factor affecting the prognosis of proximal(Siewert type Ⅰ and type Ⅱ)AEG patients(RR=1.256,2.123,95%CI:1.042-1.515,1.426-3.126,P<0.05),and adjuvant chemotherapy was an independent protection factor for prognosis of patients(RR=0.520,95%CI:0.377-0.717,P<0.05).Conclusion1.The incidence of lower esophageal adenocarcinoma,Siewert type Ⅰ and type ⅡAEG,which is closely related to gastroesophageal reflux disease and Barrett esophagus,have an increasing trend of detection rate,the survival rate is low,and the prognosis is poor.2.Tumor N stage and tumor maximum diameter are independent risk factors for patients with lower esophageal adenocarcinoma.3.Siewert type Ⅰ and type Ⅱ AEG have close germinal centers and similar biological behaviors,and there is no significant difference in survival rates.Tumor N stage and tumor TNM stage are independent risk factors affecting the prognosis of patients with proximal(Siewert type Ⅰ and type Ⅱ)AEG.Postoperative adjuvant chemotherapy is an independent protection factor affecting their prognosis.4.The pathogenesis,clinical symptoms,and prognosis of lower esophageal adenocarcinoma and the proximal(Siewert type Ⅰ and type Ⅱ)AEG are similar.A correct lifestyle and active anti-reflux therapy are effective means to prevent lower esophageal adenocarcinoma and proximal AEG.For patients with Barrett’s esophagus and intestinalization,fine endoscopic monitoring of the lower esophagus and esophagogastric junction should be strengthened. |
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