ABSTRACT
Objective To explore the incidence and prognosis of esophageal adenocarcinoma (EAC),Siewert type Ⅰ adenocarcinoma of esophagogastric junction (AEG) and Barrett esophagus (BE) in Henan province,an area of high incidence of esophageal cancer.Methods From January 2010 to January 2015,the clinical data of 152 patients with EAC,70 patients with Siewert type Ⅰ AEG and 149 patients with BE were collected,and the clinicopathological features and treatment methods of all the patients were retrospectively analyzed.Patients with EAC and Siewert type Ⅰ AEG were followed up by telephone,while the patients with BE were followed up by telephone and endoscopy examination.The follow-up was ended in January 1st 2016 and the total follow-up period was 12 to 72 months.Chi square test,t test and one way analysis of variance were performed for comparison of pathological characteristics among groups;linear regression method was used to detect changing trends in the rates over time and Kaplan-Meier method was for survival analysis.Results The annual detection rates in five years of EAC were 0.7‰,0.9‰,0.8‰,1.1‰ and 1.1‰,respectively,suggesting an increasing trend (F=10.714,P＜0.05).The proportion of EAC to esophageal squamous carcinoma (ESC) were 2.9％,3.2％,3.1％,3.4％ and 3.8％,respectively with an increasing trend (F=17.647,P＜0.05).The one,three-and five-year overall survival rates of EAC were 57.7％,30.6％ and 15.3 ％.Among 152 patients with EAC,51 received operation and 101 patients did not.The median survival time was 14 months,and the median survival time of operation group and non-operation group was 60 months and 10 months,respectively.Survival curve layered by treatment methods indicated that the three-year survival rates of operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and notreatment group were 82.3％,50.0％,11.2％ and 0.The three-year survival rates in operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and no-treatment group were significantly different (x2 =1.099,2.236 and 11.431,all P＜0.01).The annual detection rates in five years of Siewert type Ⅰ AEG were 0.2‰,0.3‰,0.4‰,0.4‰,0.7‰,respectively,with an increasing trend (F=19.105,P＜0.05).The one-,three-and five-year overall survival rate of Siewert type Ⅰ AEG was 59.8％,30.5 ％ and 15.3 ％,respectively.Among 70 patients with Siewert type Ⅰ AEG,16 cases received operation,while 54 cases without operation.The median survival time of Siewert type Ⅰ AEG was 16 months,and the median survival time of operation group and non-operation group was 50 months and 13 months.The one-,three-and five-year survival rates of operation group were 87.5％,62.6％ and 43.0％ respectively,and the one-,threeand five-year survival rates of non-operation group were 50.2 ％,19.6 ％ and 0,respectively,and the difference in cumulative survival rate between the two groups was statistically significant (x2 =12.289,P＜ 0.05).The annual detection rates of BE in five years were 0.6‰,0.5‰,0.9‰,0.9‰ and 1.1‰,respectively,with an increasing trend (F=13.364,P＜0.05).Among 149 patients with BE,there were 24 cases with specialized intestinal metaplasia and six cases with dysplasia,but none of them developed into adenocarcinoma during the follow-up period.Conclusions In Henan province,an area with high incidence of esophageal cancer,there is an increasing trend in the annual detection rates in five years of EAC,Siewert type Ⅰ AEG and BE.Although the incidence of EAC and Siewert type Ⅰ AEG is not high,the prognosis is poor with low survival rate.The prognosis of non-operation group is obviously worse than that of operation group.Specialized intestinal metaplasia and dysplasia in patiens with BE are rare and have a low probability of developing into adenocarcinoma.
ABSTRACT
Objective To explore the incidence and prognosis of esophageal adenocarcinoma (EAC),Siewert type Ⅰ adenocarcinoma of esophagogastric junction (AEG) and Barrett esophagus (BE) in Henan province,an area of high incidence of esophageal cancer.Methods From January 2010 to January 2015,the clinical data of 152 patients with EAC,70 patients with Siewert type Ⅰ AEG and 149 patients with BE were collected,and the clinicopathological features and treatment methods of all the patients were retrospectively analyzed.Patients with EAC and Siewert type Ⅰ AEG were followed up by telephone,while the patients with BE were followed up by telephone and endoscopy examination.The follow-up was ended in January 1st 2016 and the total follow-up period was 12 to 72 months.Chi square test,t test and one way analysis of variance were performed for comparison of pathological characteristics among groups;linear regression method was used to detect changing trends in the rates over time and Kaplan-Meier method was for survival analysis.Results The annual detection rates in five years of EAC were 0.7‰,0.9‰,0.8‰,1.1‰ and 1.1‰,respectively,suggesting an increasing trend (F=10.714,P＜0.05).The proportion of EAC to esophageal squamous carcinoma (ESC) were 2.9％,3.2％,3.1％,3.4％ and 3.8％,respectively with an increasing trend (F=17.647,P＜0.05).The one,three-and five-year overall survival rates of EAC were 57.7％,30.6％ and 15.3 ％.Among 152 patients with EAC,51 received operation and 101 patients did not.The median survival time was 14 months,and the median survival time of operation group and non-operation group was 60 months and 10 months,respectively.Survival curve layered by treatment methods indicated that the three-year survival rates of operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and notreatment group were 82.3％,50.0％,11.2％ and 0.The three-year survival rates in operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and no-treatment group were significantly different (x2 =1.099,2.236 and 11.431,all P＜0.01).The annual detection rates in five years of Siewert type Ⅰ AEG were 0.2‰,0.3‰,0.4‰,0.4‰,0.7‰,respectively,with an increasing trend (F=19.105,P＜0.05).The one-,three-and five-year overall survival rate of Siewert type Ⅰ AEG was 59.8％,30.5 ％ and 15.3 ％,respectively.Among 70 patients with Siewert type Ⅰ AEG,16 cases received operation,while 54 cases without operation.The median survival time of Siewert type Ⅰ AEG was 16 months,and the median survival time of operation group and non-operation group was 50 months and 13 months.The one-,three-and five-year survival rates of operation group were 87.5％,62.6％ and 43.0％ respectively,and the one-,threeand five-year survival rates of non-operation group were 50.2 ％,19.6 ％ and 0,respectively,and the difference in cumulative survival rate between the two groups was statistically significant (x2 =12.289,P＜ 0.05).The annual detection rates of BE in five years were 0.6‰,0.5‰,0.9‰,0.9‰ and 1.1‰,respectively,with an increasing trend (F=13.364,P＜0.05).Among 149 patients with BE,there were 24 cases with specialized intestinal metaplasia and six cases with dysplasia,but none of them developed into adenocarcinoma during the follow-up period.Conclusions In Henan province,an area with high incidence of esophageal cancer,there is an increasing trend in the annual detection rates in five years of EAC,Siewert type Ⅰ AEG and BE.Although the incidence of EAC and Siewert type Ⅰ AEG is not high,the prognosis is poor with low survival rate.The prognosis of non-operation group is obviously worse than that of operation group.Specialized intestinal metaplasia and dysplasia in patiens with BE are rare and have a low probability of developing into adenocarcinoma.
ABSTRACT
Objective To explore the clinicopathologic characteristics,to screen risk factors of metastasis and to analyze the diagnosis,treatment and prognosis of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).Methods From January 2010 to November 2015,the clinical data of 405 patients with GEP-NEN were retrospectively analyzed.GEP-NEN tumors were classified as neuroendocrine tumor (NET,G1 and G2 grade),neuroendocrine carcinoma (NEC,G3 grade) and mixed adenoendocrine carcinoma (MANEC,G3 grade).The clinicopathologic characteristics were summarized.The staining characteristics of synaptophysin (Syn),chromogranin A (CgA) and CD56 of tumor tissues were analyzed by immunohistochemistry.x2 and t test were performed to analyze differences in pathologic characteristics between groups.Logistics regression method was used to analyze the risk factors of metastasis.KaplanMeier method and Log-rank test were used for survival analysis.Results The mean age of patients with GEP-NEN was (54.7± 13.3) years.Gastric NEN was the most common GEP-NEN (98 cases,24.2％),followed by 95 cases (23.5％) with NEN in rectum,86 cases (21.2％) in pancreas and 50 cases (12.3％)in esophagus.Among them,47 cases (11.6％) were functional GEP NEN and 358 cases (88.4％) were non-functional GEP-NEN.According to pathologic diagnosis,227 cases (56.0％) were NET,125 cases (30.9％) were NEC and 16 cases (4.0％) were MANEC.According to tumor classification,120 cases (29.6％) were grade G1,108 cases (26.7％) were grade G2 and 177 cases (43.7％) were grade G3.Immunohistochemistry staining positive ratesof Syn,CgA and CD56 were 97.4 ％ (381/391),44.0 ％ (121/275) and 83.9％(291/347),respectively.The median (lower quartile,upper quartile) diameter of grade G1,G2 and G3 tumors were 1.0 cm (0.6 cm,1.5 cm),1.5 cm (1.0 cm,2.5 cm),4.0 cm(2.5 cm,6.0 cm),respectively,and the difference was statistically significant (Z =99.171,P ＜ 0.01).The positive rate of CgA of grade G3 tumor was lower than that of grade G1 and G2(x2 =7.078 and 11.391,both P＜ 0.01).The results of Logistic regression analysis revealed that tumor size and pathologic classification were the important predictors of metastasis.The median survival time of metastasis group and non-metastasis group of grade G3 was 12.0 months and 41.5 months,and there was a significant difference between the two groups by Log-rank test (x2 =37.075,P＜0.01).Conclusions GEP-NEN may occur at any part of the digestive system.There are differences in tumor size positive rate of,immunohistochemistry staining and the primary site of tumors with different pathological grading.The tumor diameter and pathologic classification are the important predictors of metastasis.The prognosis of metastasis group is worse than that of non-metastasis group.