文章：

胃食管结合部腺癌独立分期分类法

Independent Stage Classification for Gastroesophageal Junction Adenocarcinoma

原文发布日期：25 October 2023

DOI: 10.3390/cancers15215137

类型: Article

开放获取: 是

英文摘要：

In gastroesophageal junction (GEJ) adenocarcinoma cases, a prognosis based on ypTNM staging could be affected by preoperative therapy. Patients with esophageal adenocarcinoma and gastric adenocarcinoma who underwent preoperative therapy followed by surgical resection from 2006 through 2017 were identified in the National Cancer Database. To enable stage-by-stage OS comparisons, tumors were classified into four gross ypTNM groups: ypT1/2, N-negative; ypT1/2, N-positive; ypT3/4, N-negative; and ypT3/4, N-positive. Prognostic factors were examined, and an OS prediction nomogram was developed for patients with abdominal/lower esophageal and gastric cardia adenocarcinoma, representing GEJ cancers. We examined 25,463 patient records. When compared by gross ypTNM group, the abdominal/lower esophageal and gastric cardia adenocarcinoma groups had similar OS rates, differing from those of other esophageal or gastric cancers. Cox regression analysis of patients with GEJ cancers showed that preoperative chemoradiotherapy was associated with shorter OS than preoperative chemotherapy after adjustment for the ypTNM group (hazard ratio 1.31, 95% CI 1.24–1.39,p< 0.001), likely owing to downstaging effects. The nomogram had a concordance index of 0.833 and a time-dependent area under the curve of 0.669. OS prediction in GEJ adenocarcinoma cases should include preoperative therapy regimens. Our OS prediction nomogram provided reasonable OS prediction for patients with GEJ adenocarcinoma, and future validation is needed.

摘要翻译： 

在胃食管结合部（GEJ）腺癌病例中，基于术后病理分期（ypTNM）的预后评估可能受到术前治疗的影响。本研究从美国国家癌症数据库中筛选出2006年至2017年间接受术前治疗并后续手术切除的食管腺癌和胃腺癌患者。为进行分期生存率比较，将肿瘤按大体ypTNM分为四组：ypT1/2期淋巴结阴性、ypT1/2期淋巴结阳性、ypT3/4期淋巴结阴性及ypT3/4期淋巴结阳性。通过分析预后因素，针对代表GEJ癌的腹部/下段食管及胃贲门腺癌患者构建了总生存期预测列线图。研究共纳入25,463例患者病历。按大体ypTNM分组比较发现，腹部/下段食管与胃贲门腺癌组的总生存率相近，但与其他食管癌或胃癌存在差异。对GEJ癌患者的Cox回归分析显示，在校正ypTNM分期后，术前放化疗较术前化疗具有更短的总生存期（风险比1.31，95%置信区间1.24–1.39，p<0.001），这可能与降期效应相关。列线图的一致性指数为0.833，时变曲线下面积为0.669。GEJ腺癌的总生存期预测应纳入术前治疗方案考量。本研究构建的列线图为GEJ腺癌患者提供了合理的生存预测工具，未来仍需进一步验证。

原文链接：

Independent Stage Classification for Gastroesophageal Junction Adenocarcinoma