近端胃切除对比全胃切除治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌安全性及预后的倾向性评分匹配研究  

Comparative study with propensity score matching of gastrectomy versus total gastrectomy for the safety and prognosis of Siewert typesⅡandⅢadenocarcinoma of the esophagogastric junction

作　　者：王博 杨瑞[2] 乔鋆 张茂杰 杨垠浩 王杰 王楠 张晋杰 魏晓楠 崔鹏 魏伟 李勇爱 王宇[1] 胡文庆[1] Wang Bo;Yang Rui;Qiao Yun;Zhang Maojie;Yang Yinhao;Wang Jie;Wang Nan;Zhang Jinjie;Wei Xiaonan;Cui Peng;Wei Wei;Li Yongai;Wang Yu;Hu Wenqing(Department of Gastrointestinal Surgery,Changzhi People's Hospital Affiliated to Changzhi Medical College Clinical Medical Research Center for Malignant Tumor(Esophagogastric junction carcinoma)of Shanxi Province,Changzhi 046099,China;Department of Gastroenterology,the Affiliated Yuncheng Central Hospital,Shanxi Medical University,Yuncheng 044099,China)

机构地区：[1]山西省恶性肿瘤(食管胃结合部癌)临床医学研究中心、长治医学院附属长治市人民医院胃肠外科,长治046099 [2]山西医科大学附属运城市中心医院消化内科,运城044099

出　　处：《中华胃肠外科杂志》2025年第2期169-177,共9页Chinese Journal of Gastrointestinal Surgery

基　　金：山西省卫健委四个一批-重大科技攻关专项(2022XM02);吴阶平医学基金会(320.6750.2020-11-6)。

摘　　要：目的对比Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌行近端胃切除术(PG)与全胃切除术(TG)的安全性、淋巴结清扫和转移情况以及预后。方法采用回顾性队列研究方法。收集2019年12月至2022年11月期间, 在长治医学院附属长治市人民医院确诊为食管胃结合部腺癌患者的临床资料, 排除术前接受新辅助治疗、胃部多发恶性病灶或合并其他部位恶性肿瘤、临床资料缺失以及失访的患者。共计308例患者纳入研究, 其中PG组99例, TG组209例。为减少混杂偏倚, 采用倾向性评分匹配(PSM)的方法, 对接受PG和TG的患者依据年龄、性别、体质指数、肿瘤长径和病理分期等因素进行1∶1匹配后, PG组与TG组各73例。主要观察指标为手术情况、淋巴结清扫数目与转移率、术后并发症和住院时间以及随访及生存情况。结果 PSM后, PG组比TG组手术时间短(中位数250 min比280 min, Z=-4.970, P<0.001)、术中出血量>100 ml者少[22例(22/73, 30.1%)比34例(34/73, 46.6%), χ^(2)=4.171, P=0.041]、淋巴结清扫数量少(中位数33枚比46枚, Z=-4.774, P<0.001), 差异均有统计学意义(均P<0.05)。两组患者的术后住院天数和术后并发症比较, 差异无统计学意义(均P>0.05)。PG组与TG组No.1、No.2、No.3、No.4sa、No.4sb和No.7淋巴结清扫数目及淋巴结转移率比较, 差异均无统计学意义(均P>0.05)。TG组209例患者远端胃周淋巴结(No.4d、No.5和No.6)转移的危险因素分析结果显示, 肿瘤长径≤4 cm且T1~3期的患者远端胃周淋巴结转移率明显低于肿瘤长径>4 cm和(或)T4期患者[0/78比12/131(9.2%)], 差异具有统计学意义(P=0.014)。全组中位随访时间为26个月, PG组和TG组的3年OS分别为62.5%和63.3%, 两组比较, 差异无统计学意义(χ^(2)=0.330, P=0.565)。多因素分析显示, 患者年龄大(P=0.035)和肿瘤病理分期差(P=0.018)是影响本研究中SiewertⅡ型和Ⅲ型AEG患者OS的独立危险因素。结论对于SiewertⅡ型Objective To compare the safety,number of lymph nodes removed,rate of lymph node metastasis,and prognosis between proximal gastrectomy(PG)and total gastrectomy(TG)in patients with Siewert types II and III adenocarcinoma of the esophagogastric junction.Methods In this retrospective cohort study,clinical data of patients diagnosed with adenocarcinoma of the esophagogastric junction at Changzhi People's Hospital,affiliated with Changzhi Medical College,between December 2019 and November 2022,were collected.Patients who had received neoadjuvant therapy,had multiple malignant lesions in the stomach,had concomitant malignancies in other organs,had incomplete clinical data,or had been lost to follow-up were excluded.The study cohort comprised 308 patients,99 in the PG group and 209 in the TG group.To reduce confounding bias,propensity score matching was performed,matching patients for age,sex,body mass index,tumor diameter,and pathological stage in a 1:1 ratio,resulting in 73 patients in each group.The primary outcomes assessed were operative details,number of lymph nodes dissected,rate of lymph node metastasis,postoperative complications,duration of hospital stay,and follow-up and survival outcomes.Results The PG group had a significantly shorter median operative time than did the TG group(250 vs.280 minutes,Z=−4.970,P<0.001),with fewer cases of intraoperative blood loss>100 mL(30.1%[22/73]vs.46.6%[34/73],χ²=4.171,P=0.041),and a smaller number of lymph nodes removed(median 33 vs.46,Z=−4.774,P<0.001);all of these differences are statistically significant(all P<0.05).Differences between the two groups in postoperative hospital stay and postoperative complications were not statistically significant(both P>0.05).Furthermore,no statistically significant differences were found between the PG and TG groups in the number of lymph nodes dissected or the lymph node metastasis rates at stations No.1,No.2,No.3,No.4sa,No.4sb,and No.7(all P>0.05).Among the 209 patients in the TG group,analysis of risk factors for metastasis to

关 键 词：食管胃结合部腺癌 Siewert分型 近端胃切除术 全胃切除术 预后 

分 类 号：R73[医药卫生—肿瘤]