| Objective:To analyze the clinicopathological features,surgical methods and prognosis of esophageal and gastric junction adenomas treated by operation,and to explore the independent risk factors affecting the survival of patients with esophageal and gastric junction adenomas,so as to provide evidence for the accurate treatment of different clinical types of esophagus and stomach junction adenomas.The clinicopathological features and prognostic factors of esophagus and stomach junction carcinoma and gastric antral carcinola were further analyzed and compared.Methods:A total of 256 patients with carcinoma of esophagus and stomach in Qilu Hospital of Shandong University from January 1,2015 to December 31,2015 were analyzed retrospectively.The results showed that 256 patients with carcinoma of esophagus and stomach were treated in Qilu Hospital of Shandong University.476 patients with gastric antral carcinona were selected as control.The basic information.operation time,operation mode and pathological stage of the patients were collected.The selected patients were followed up retrospectively,including outpatient follow-up,telephone follow-up.or postoperative chemotherapy in-patient follow-up,and the postoperative survival time of the patients in the follow-up group.The deadline for followtup was 3 1 December 2018.The survival curve was analyzed by Kaplan-Meier method.Multivariate COX regression model was used to analyze the independent risk factors affecting prognosis.Results:The median age of 256 patients with carcinoma of esophagus and stomach was 61(31≤84)years old.170(66.4%)were males.31 cases(12.1%)underwent radical resection of proximal gastric cancer,225 cases(87.9%)underwent total gastroresection,112 cases(43.8%)underwent open operation and 144 cases(56.2%)underwent laparoscopic surgery.Univariate analysis showed that the 3-year survival rate of patients with hypoprenemia,tumor diameter>4 cm,elevated serum CEA,vascular infiltration,pathological poor differentiation and Ⅲ stage of TNM stage decreased.The results of COX multivariate regression analysis showed that albumin<30 g ≤ L(HR=1.32;95%CI:1.06-1.64;P≤0.01),vascular infiltration(HR=1.29;95%CI:1.04-1.60;P≤0.02),nerve invasion(HR=1.13;95%CI:1.05-1.21;P≤0.01).tumor low-differential differentiation(HR=2.14;95%CI:1.16-3.95;)P≥0.02),TNM stage Ⅲ(HR=1.12;95%CI:1.02-1.25;P≤0.02).R1 resection was an independent risk factor for prognosis in patients with combined esophagus and stolach cancer(HR=3.61;95%CI:2.37-4.56;P<0.001).Siewert classification,age,sex.surgical mode and so on are not independent risk factors for prognosis.Compared with gastric antral gland carcinoma,the patients with carcinoma of esophagus and stomach were older in age,lower in albumin level,higher in serum CEA higher in the proportion of low differentiation and poor differentiation.larger in diameter,and higher in the Ⅲ stage of TNM stage(all P<0.05).The 3-year survival rate of patients with combined carcinoma of esophagus and stomach was 60.9%,which was significantly lower than that of patients with gastric antral carcinoma(76.1%).Conclusion:1.Hypoalbuminenia,vascular nerve infiltration tumor low-poor differentiation and TNM stage were independent risk factors for prognosis in patients with combined esophagus and stomach cancer,while Siewert classification,age,sex,surgical mode and so on were not the risk factors for prognosis,and Siewert classification,age,sex,surgical mode and so on were not the risk factors for prognosis.2.Compared with gastric antral carcinoma,the patients with carcinoma of esophagus and stomach were older in age,lower in albumin level,higher in serum CEA,higher in the proportion of low differentiation and poor differentiation.larger in diameter,and higher in the Ⅲ stage of TNM stage.The 3-year survival rate of patients with combined carcinoma of esophagus and stomach was significantly lower than that of patients with gastric antral carcinoma... |
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