首页|Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus
Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus
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NETL
NSTL
万方数据
维普
AIM:To investigate the clinicopathologic features which predict surgical overall survival in patients with proximal gastric carcinoma involving the esophagus (PGCE).METHODS:Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009.Each retrieved pathology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were selected as PGCE.Each tumor was re-staged,following the guidelines on esophageal adenocarcinoma,according to the 7th edition of the American Joint Commission on Cancer Staging Manual.All histology slides were studied along with the pathology report for a retrospective analysis of 13 clinicopathologic features,i.e.,age,gender,Helicobacter pylori (H.pylori) infection,surgical modality,Siewert type,tumor Bormann's type,size,differentiation,histology type,surgical margin,lymphovascular and perineural invasion,and pathologic stage in relation to survival after surgical resection.Prognostic factors for overall survival were assessed with uniand multi-variate analyses.RESULTS:Patients' mean age was 65 years (range:47-90 years).The male:female ratio was 3.3.The 1-,3-and 5-year overall survival rates were 87％,61％ and 32％,respectively.By univariate analysis,age,male gender,H,pylori,tumor Bormann's type,size,histology type,surgical modality,positive surgical margin,lymphovascular invasion,and pT stage were not predictivefor overall survival; in contrast,perineural invasion (P =0.003),poor differentiation (P =0.0003),＞ 15 total lymph nodes retrieved (P =0.008),positive lymphnodes (P =0.001),and distant metastasis (P =0.005)predicted poor post-operative overall survival.Celiac axis nodal metastasis was associated with significantly worse overall survival (P =0.007).By multivariate analysis,≥ 16 positive nodes (P =0.018),lymph node ratio ＞ 0.2 (P =0.003),and overall pathologic stage (P =0.002) were independent predictors for poor overall survival after resection.CONCLUSION:Patients with PGCE showed worse overall survival in elderly,high nodal burden and advanced pathologic stage.This cancer may be more accurately staged as gastric,than esophageal,cancer.
Yi-Fen Zhang、Jiong Shi、Hui-Ping Yu、An-Ning Feng、Xiang-Shan Fan、Gregory Y Lauwers、Hiroshi Mashimo
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Department of Pathology, Nan-jing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province,China
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,United States
Department of Gastroenterology, Veterans Affairs Boston Healthcare System, Harvard Medical School,West Roxbury, MA 02132, United States
Key Grants from the Science and Technology Development Project of the Nanjing CityKey Grants from the Science and Technology Development Project of the Nanjing CityA Special Grant from the Nanjing Drum Tower Hospital,Nanjing,China
NETL
NSTL
万方数据
维普
