| Objective: The most effective treatment for the patients with gastro esophageal junction carcinoma and distal gastric carcinoma is the radical surgery, but a lot of factors, including clinical, pathological and many other aspects may affect the prognosis, and that has not been determined at present. There is no broad-accepted standard for gastro esophageal junction carcinoma, the preliminary study made the gastro esophageal junction carcinoma as part of gastric carcinoma, as well as the distal gastric carcinoma, and analyzing their prognosis and independent prognostic factors. While the gastro -esophageal junction carcinoma has its own autopsy and histopathological characteristics. A growing number of medical scholars believe that it is an independent disease, and that's also the starting point of this study, in which it will analyze the two separately, aimed to thoroughly understand the prognosis of thoracic esophageal carcinoma and gastro esophageal junction carcinoma. and thus to guide the clinicians to choose more rational treatment for different patients under different clinical and pathological, and get a better individual treatment for postoperative recurrence or metastasis, for doing this, we also expecting to make a useful exploration in related area.According to the statistic of the nation-wide gastric carcinoma patients, the 5 year survival rate is just only 37%～50%. And the medical experts from all over the world has made their agreement in that the postoperative adjuvant chemotherapy can postpone or prevent the recrudesce and transfer at a certain extent, it can extend the patient's survival time, and also improve the life quality. While in the other hand, there is not a standard precept for this. The treatment for the gastro esophageal junction carcinoma is always according to the gastric carcinoma treatment guidance, we are not find the "Golden standard" for both of them. Nowadays, the oxaliplatin's role in digestive tract malignant tumor treatment is becoming more and more important, and this study will make a compare with FLOFOX regimen and the LFP regimen.Method: We have selected 340 hospitalized patients'data with the "gastric carcinoma" and "cardiac carcinoma" in the medical oncology department of Fourth Hospital of Hebei Medical University from March 2007 to October 2008 to review and study, and then we also re-classed the cases according to their endoscopy, surgical situation. We define the lesions which lesion center locat between 5 cm proximal or distal of the EGJ as gastro esophageal junction carcinoma. And defined the other as distal gastric carcinoma. The dates were input to ACCESS database after encoded. A follow-up study was carried out on the sample, and continuing diagnose was made by sending post letter or make phone-call to those patients. For this phase, the operation time was looked as the starting point and the end point can be decided as the death of the patient, lost in contact or the last time of diagnose. All confirmed analyses data were performed and by using SPSS13.0 software package.We collected fourteen possible factors influencing survival of these patients, by using COX proportional hazard model analysis, we can get the independent prognostic determinants of the gastro esophageal junction carcinoma and distal gastric carcinoma. (The variables that P <0.10 in univariate analysis was brought into multivariate COX proportional hazard model analysis. The clinical stage was determined by lymph node metastasis status and invasive depth. The surrounding organs invasion status can be reflected in the invasive depth. So we exclusion clinical stage and surrounding organs invasion status from multivariate analysis.) Chi-square test was used for the enumeration data comparison, Kaplan-Meier was used for survival time analysis and the univariate and multivariate analysis of these individual variables were performed by Cox proportional hazard model. All tests were performed at the 0.05 level of significances. Result: There are 340 patients were included in follow-up examples, and there are 158 deaths (50.3%) and 11 patients contacting lost (3.2%). There are 200 patients of distal gastric cancer,in which there are 87 deaths (43.5%) and 4 cases lost (2.0%). There are 140 cases of gastro esophageal junction carcinoma, in which there are 71 deaths (50.7%) and 7 cases lost (5.0%). The results of this study are as follows:1. The differences between gastro esophageal junction carcinoma and distal gastric carcinoma in the clinical and pathological characters are as follow: age, lesion extent, invasive depth, lymph node metastasis status, clinical stage, stump status, degrees of nodes dissection, resection range.2. COX analysis2.1 The cox analysis of the overall cases2.1.1 Univariate analysisThe prognostic affecting factors includes invasive depth, lymph node metastasis status, clinical stage, nearby organs involved status, carcinoma cell embolus, degrees of nodes dissection, resection range.2.1.2 Multivariate analysisThe independent prognostic determinants includes lesion sites, invasive depth, lesion extent, lymph node metastasis status, degrees of nodes dissection. (P<0.05)2.1.2.1 Lesion sites: the mortality risk of distal gastric carcinoma is 0.390 times of gastro esophageal junction carcinoma(P=0.000).2.1.2.2 Lesion extent: the mortality risk of >5.0cm group is 1.602 times of≤5cm group.2.1.2.3 Invasive depth: the mortality risk of T2,T3,T4 group is 2.464 times, 6.459 times, 13.008 times of T1 group separately.2.1.2.4 Lymph node metastasis status: the mortality risk of N2,N3,N4 group is 1.389 times, 2.088 times, 3.252times of N1 group separately.2.1.2.5 Degrees of nodes dissection: the mortality risk of D2 type radical resection group is 0.379 times of D1 type radical resection group.2.2 The cox analysis of gastro esophageal junction carcinoma 2.2.1 Univariate analysisThe prognostic affecting factors include invasive depth, lymph node metastasis status, clinical stage, nearby organs involved status, stump status, degrees of nodes dissection, resection range.2.2.2 Multivariate analysisThe independent prognostic determinants include invasive depth, lymph node metastasis status, degrees of nodes dissection. (P<0.05)2.2.2.1 Invasive depth: the mortality risk of T3,T4 group is 4.013 times, 12.449 times, 13.008 times of T2 group separately.2.2.2.2 Lymph node metastasis status: the mortality risk of N2,N3,N4 group is 0.983times, 1.915 times, 2.769times of N1 group separately.2.2.2.3 Degrees of nodes dissection: the mortality risk of D2 type radical resection group is 0.366 times of D1 type radical resection group.2.3 The cox analysis of distal gastric carcinoma2.3.1 Univariate analysisThe prognostic affecting factors include lesion extent, invasive depth, lymph node metastasis status, clinical stage, nearby organs involved status, carcinoma cell embolus, degrees of nodes dissection, resection range.2.3.2 Multivariate analysisThe independent prognostic determinants include lesion extent, lymph node metastasis status, degrees of nodes dissection. (P<0.05)2.3.2.1 lesion extent: the mortality risk of >5.0cm group is 2.418 times of≤5cm group.2.3.2.2 Lymph node metastasis status: the mortality risk of N2,N3,N4 group is 1.838 times, 2.408 times, 4.097times of N1 group separately.2.3.2.3 Degrees of nodes dissection: the mortality risk of D2 type radical resection group is 0.366 times of D1 type radical resection group.3. Comparison of postoperative adjuvant chemotherapy (LFP regimen compared FOLFOX4 regimen)3.1 Balance testWe choose elements which are easily to get in the actual clinical work and affect clinicians choosing chemotherapy regimen, as age gender, pathological type, clinical stage and lesion sites (only the general cases involved).The balance test of these clinical and pathological datas are indicating there were no statistically significant difference betweent the two groups.3.2 Disease-free survivalIn the whole cases, the average disease-free survival period of FOLFOX4 regimen group is 50.251 months, LFP regimen group is 37.156 months, P=0.002, there are statistically significant.In the gastro esophageal junction carcinoma cases, the average disease-free survival period of FOLFOX4 regimen group is 38.957 months, LFP regimen group is 33.146 months, P=0.012, there are statistically significant.In the distal gastric carcinoma cases, the average disease-free survival period of FOLFOX4 regimen group is 48.971 months, LFP regimen group is 40.336 months, P=0.108, there are no statistically significant.3.3 Overall survivalIn the whole cases, the overall survival of FOLFOX4 regimen group is 53.567 months, LFP regimen group is 45.418 months, P=0.019, there are statistically significant.In the gastro esophageal junction carcinoma cases, the overall survival of FOLFOX4 regimen group is 40.434 months, LFP regimen group is 33.890 months, P=0.009, there are statistically significant.In the distal gastric carcinoma cases, the overall survival of FOLFOX4 regimen group is 53.268 months, LFP regimen group is 53.099 months, P=0.649, there are no statistically significant.Conclusion:1. Comparing distal gastric, gastro-esophageal junction carcinoma has some different clinical and pathological features and independent prognostic determinants. That indicate the tow disease have a close relationship, at the same time, they have some differences too. 1) Gastro esophageal junction carcinoma has worse prognostic than distal gastric carcinoma. 2) Invasive depth is the independent prognostic determinants of gastro esophageal junction carcinoma. The deeper, the worse the prognosis is. Lesion extent is the independent prognostic determinants of distal gastric carcinoma. The longer, the worse the prognosis is. 3) Lymph node metastasis status, and degrees of nodes dissection are the independent prognostic determinants of both gastro esophageal junction carcinoma and distal gastric carcinoma. The more number of lymph node metastasis, the worse the prognosis. D2-type radical resection can bring even greater survival benefit than the D1-type radical resection.2. Within the overall case and gastro esophageal junction carcinoma, comparing LFP regimen, the application of FOLFOX4 regimen in adjuvant chemotherapy can take a longer disease-free survival and overall survival. Within the distal gastric carcinoma, there were no statistically significant difference in disease-free survival and overall survival. |
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