CT区分Siewert Ⅱ型食管胃结合部腺癌cT3与cT4a：国际抗癌联盟／美国癌症联合委员会（UICC／AJCC）第8版分期与国际胃癌协会（IGCA）第4版分期对照研究  

CT in differentiation of cT3 and cT4a Siewert type Ⅱ esophagogastric junction adenocarcinoma： A comparison study based on UICC/AJCC 8th edition and IGCA 4th edition

作　　者：付佳 唐磊[1] 李子禹[2] 李晓婷[1] 张燕[2] 高顺禹 孙应实[1] 季加孚[2] Fu Jia;Tang Lei;Li Ziyu;Li Xiaoting;Zhang Yah;Gao Shunyu;Sun Yingshi;Ji Jiafu(Department of Radiology,Peking University Cancer Hospital ＆ Institute,Key Laboratory of Carcinogenesis and Translational Research（Ministry of Education）,Beijing 100142,China（Fu J,Tang L,Li XT,Gao SY,Sun YS;Gastrointestinal Cancer Center,Peking University Cancer Hospital ＆ Institute,Key Laboratory of Carcinogenesis and Translational Research（Ministry of Education）,Beijing 100142,China（Li ZY,Zhang Y,Ji JF)

机构地区：[1]恶性肿瘤发病机制及转化研究教育部重点实验室北京大学肿瘤医院暨北京市肿瘤防治研究所医学影像科,100142 [2]恶性肿瘤发病机制及转化研究教育部重点实验室北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心,100142

出　　处：《中华胃肠外科杂志》2018年第9期1013-1018,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81371715）;首都临床特色应用研究与成果推广（Z161100000516060）;北京市医管局青苗计划（QML20161102）

摘　　要：目的探讨在国际抗癌联盟／美国癌症联合委员会（UICC／AJCC）第8版分期和国际胃癌协会（IGCA）第4版分期标准下，术前CT区分Siewert Ⅱ型食管胃结合部腺癌cT3与cT4a分期的准确性。方法回顾性分析43例术后病理证实为pT3或pT4a期Siewert Ⅱ型食管胃结合部腺癌的cT影像资料。病例入组标准：（1）既往无胃部手术和放化疗、靶向治疗病史以及无CT增强扫描禁忌证：（2）CT显示胃腔充盈良好，图像清晰无伪影，腹部三期增强扫描均获得轴冠矢三平面重建图像；（3）CT检查后1周内手术；（4）手术判断为SiewertⅡ型食管胃结合部腺癌，术后病理pL或pT4a期。由两名影像医生盲法评估，轴位联合冠状位测量肿瘤中心距食管胃交界线的距离，并判断肿瘤外侵情况。分别按UICC／AJCC第8版及IGCA第4版分期标准（SiewertⅡ型食管胃结合部腺癌，UICC／AJCC建议按食管癌分期，IGCA建议按胃癌分期）判定cT分期，并比较两者与一分期的一致性。结果43例Siewert Ⅱ型食管胃结合部腺癌患者术前CT检查显示：肿瘤中心距食管胃交界线长度0．7～2．5（1．5±0．4）cm，其中41例≤2cm；与手术判断的符合率高达95．3％（41／43）。IGCA分期：cT3期18例，cT4a期25例。UICC／AJCC分期：41例CT测量肿瘤中心点位于食管胃交界线下方2cm内，按食管癌分期为ct3;2例位于2cm之外，按胃癌分期，其中1例浆膜面光滑分为cT3，1例浆膜侧密集索条分为cT4a。术后病理：pT3期33例，pT4a期10例。根据IGCA第4版和UICC／AJCC第8版分期标准，CT区分T3和T4a的准确率分别为65．1％（28／43）和74．4％（32／43），差异有统计学意义（P〈0．01）。结论术前cT检查可较准确地定位SiewertⅡ型食管胃结合部腺癌的2cm阈值线，从而辅助区分cT3和cT4a期食管胃结合部腺癌。采用UICC／AJCC第8版分期标准区分cT3与cT4a分期的准确率高于IGCA第4版分�Objective To investigate the accuracy of CT in preoperative discrimination of cT3 from cT4 in patients with Siewert Ⅱ esophagogastrie junction （EGJ） adenocareinoma according to UICC/ AJCC 8th edition and IGCA 4th edition. Methods CT imaging data of 43 consecutive patients with Siewert Ⅱ EGJ adenocareinoma who underwent preoperative CT and were diagnosed as pT3 or pT4 by postoperative pathology were retrnspectively analyzed. Inclusion criteria were as follows： （1）no previous history of gastric operation, radiochemotherapy, targeted treatment; no contraindications of CT enhanced scanning; （2） good filling of gastric cavity by CT, clear image without artifacts, all axial-coronal-sagittal 3-plane reconstruction images obtained by abdominal stage 3 enhanced scan; （3） operation within 1 week after CT examination; （4） Siewert Ⅱ EGJ adenocarcinoma confirmed by operation, pT3 and pT4 by postoperative pathology. Transverse and muhiplanar reconstruction images were reviewed by two radiologists in double-blind method. Distance between cancer epicenter and esophagogastric junction line, and the contour of the serosa were retrospectively measured on CT scans. The cT staging judgment was performed according to the UICC/AJCC 8tb edition （Siewert Ⅱ EGJ adenocarcinoma should be staged as esophageal cancer） and IGCA 4th edition （Siewert Ⅱ EGJ adenocarcinoma should be staged as gastric cancer） respectively. Consistency of cT staging and pathological pT staging was compared between UICC/AJCC and IGCA. Results Preoperative CT revealed that the mean length between tumor epicenter and esophagogastric junction line was （1.5±0.4） cm （0.7±2.5cm）, and such length was ≤2 cm in 41 cases, whose concordance with surgical judgment was 95.3%（41/43）. IGCA staging： 18 cases were preoperatively assessed as cT3 and 25 cases as cT4a. UICC/AJCC staging： 41 cases with eancer epicenter locating within 2 cm below esophagogastric junction line were staged as cT3 according to esophageal cancer stag

关 键 词：食管胃结合部腺癌 SiewertⅡ型 T分期 体层摄影术 X线计算机 

分 类 号：R735[医药卫生—肿瘤]