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　　近日在線出版的《外科腫瘤學年鑒》(Annalsof Surgical Oncology)雜志上，發(fā)表了日本神奈川癌癥中心Shinichi Hasegawa博士等人的一項研究結果，該研究對食管癌TNM分期標準還是胃癌TNM分期標準更適用于II/III型食管胃結合部腺癌(AEG)患者分級進行了闡明。這項研究結果發(fā)現，與食管癌TNM分期標準相比，胃癌TNM分期標準更適用于II/III型食管胃結合部腺癌(AEG)患者分級。該研究結果可能會對下一版食管胃結合部腺癌(AEG)患者TNM分級方法修訂產生影響。

　　該項研究入選患者為II/III型食管胃結合部腺癌患者，并且這些患者曾接受D1或根治性更為徹底的巴結切除術治療。研究人員按照第七版食管癌TNM分期標準及胃癌TNM分期標準，對這些患者進行分期。該研究還對患者分布情況、各期風險比(HR)以及患者生存率離散情況進行了對比。

　　該項研究共招募了163例患者。根據食管癌TNM分期標準及胃癌TNM分期標準，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) 被認定為III期 (IIIA, III B與IIIC)，還有35例與35例患者被認定為IV期。研究人員發(fā)現，根據食管癌TNM分期標準，患者分布在IIIC期出現了大幅偏離，但根據胃癌TNM分期標準，患者分布則幾乎保持均勻。研究還發(fā)現，根據胃TNM分期標準，HR呈逐步增加趨勢，但未發(fā)現食管癌TNM分期標準存在該趨勢。根據胃TNM分期標準，II期與III期患者生存率曲線出現明顯離散(P = 0.019)，而根據食管癌TNM分期標準則不存在該現象(P = 0.204)。根據食管癌TNM分期標準，IIIA, IIIB以及IIIC期患者的5年生存率分別為69.0, 100以及38.9 %，而根據胃癌TNM分期標準，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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