ABSTRACT
Objective To analyze the related rules and prognosis analysis for lymphatic metastasis in patients for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Methods This study retrospectively reviewed 65 patients who underwent radical surgery for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction in Beijing Friendship Hospital between July 2013 and March 2017.The primary indicators were sex,age,tumor site,tumor size,macroscopic type,histological type,depth of invasion,operation,tumor emboli and carcinoma nodes.The clinical characteristics and pathological features were analyzed by using Logistic regression and Kaplan-Meier survival analysis.Follow-tup using outpatient examination and telephone interview was performed to detect patients' diseases and postoperative survival up to April 2017.Results Lymph node metastasis was observed in 41 of 65 patients (63.1％).Lymph node metastasis frequency was found in No.1,No.2,No.3,No.7,No.11 and No.110 lymph nodes.The incidences of those lymph node metastasis were 45.3％,32.5％,28.8％,22.5％,19.4％ and 8.2％.The metastasis rate of the tumors with diameter over 2 cm was higher than the tumors which were less than 2 cm (71.9％ vs 0;P =0.000);The observed rate of lymph node metastasis was 0,12.5％,69％,95.2％ in early cancer (T1) and advanced cancer (T2-T4) (P=0.000) respectively.The metastasis rate of highly differentiated Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction was 45.2％ lower than poorly differentiated tumors 79.4％ (P =0.009).Thirty-three cases were found with lymphatic embolus,28 of them (84.8％) were found to be combined with lymph node metastasis among them (P =0.001).All the differences were statistically significant (P ＜ 0.05).The results of multivariable analyzed by binary logistic regression analysis revealed that neoplasms histologic type and lymphatic embolus were independent risk factors for lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Sixty-five patients were followed up for 1-45 months,with a median time of 18.81 months.Although there was no statistically significant difference,3 years-overall survival rate showed tumor without lymph node metastasis has better prognosis than with lymph node metastasis and early stage tumor also has better prognosis than advanced tumor.Conclusions Lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction is related with histological type of tumor and lymphatic embolus.For Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction,the incidence of lymphatic metastasis were higher appear in abdominal cavity,which included No.1,No.2,No.3,No.7 and No.11;Meanwhile,the metastasis of mediastinal lymph node is given priority to No.110 lymph node.Therefore,radical total gastrectomy combined with standard D2 lymphadenectomy and No.110 lymphadenectomy are performed in order to improving the prognosis.For patients with lymph node metastasis and tumor in advanced stage,long-term prognosis remains to be further study.
ABSTRACT
Objective To study the protein expression and gene amplification of human epidermal growth factor receptor-2(Her-2)in adenocarcinoma of the gastroesophageal junction and its association with the clinicopathological features .Methods Immunohistochemical method and fluorescence in situ hybridization ( FISH) were used to detect Her -2 expression and gene amplification in 80 surgically resected gastroesophageal junction cancer tissue .We further analyzed the relationship between the gastroesophageal junction cancer histolog -ical differentiation ,as well as depth of invasion ,clinical stage and lymph node metastasis .Results Her-2 am-plification of gastroesophageal junction carcinoma by FISH was 22.5%,while the overexpression by IHC was 15%.Her-2 gene amplification and protein overexpression were correlated with the differentiation ,clinical TNM stage,invasive depth and lymph node metastasis of the carcinoma (all P<0.05).Her-2 expression was not asso-ciated with the patients age,gender,invasive depth and lymph node metastasis(P<0.05).Conclusion Her -2 protein expression and gene amplification may be a prognostic indicator for the patients with gastroesophageal junction cancer .The joint detection of Her -2 protein expression level and the gene amplification can guide the prognosis and therapy for adenocarcinoma of the gastroesophageal junction .