Objective:To compare the curative effect of transverse colon resection and extended colon resection in the treatment of transverse colon cancer, and to find a suitable surgical method to provide reference for clinical treatment.Methods:The clinicopathological data of patients with transverse colon cancer who received surgical treatment in the gastrointestinal surgery department of Guangdong Provincial People's Hospital from January 2006 to December 2019 were collected. Analyze the differences in surgical survival and clinical indicators between the two groups.Results:A total of 366 patients were included, including 58 cases of transverse colon resection and 308 cases of extended colon resection. There was no significant difference in 5-year overall survival rate and 5-year disease-free survival rate between the transverse colon resection group and the extended colon resection group (all P＞0.05).There was no significant difference in the 5-year overall survival rate between the transverse colon resection group and the extended colon resection group in patients with TNM stage I, II and III (all P＞0.05).The amount of intraoperative bleeding in the transverse colon resection group was less than that in the extended colon resection group [(55.0±29.0) mL, (96.9±28.3) mL], and the number of lymph nodes cleared in the transverse colon resection group was less than that in the extended colon resection group [(19.5±8.4), (23.1±11.4)], which were statistically significant (all P＜0.05).The results of univariate analysis showed that postoperative T stage, postoperative N stage, vascular cancer thrombus invasion, postoperative chemotherapy, surgical approach, tumor gross classification, and tumor differentiation were risk factors affecting patient prognosis (all P＜0.05).The inclusion of single factor risk factors in multivariate analysis showed that postoperative T stage, postoperative N stage, vascular tumor thrombus invasion, postoperative chemotherapy, surgical approach, tumor gross classification, and tumor differentiation were all independent risk factors affecting patient survival and prognosis (all P＜0.05).Conclusion:Transverse colectomy has the same long-term prognosis as extended colectomy in the treatment of patients with transverse colon cancer. Transverse colectomy does not increase the risk of postoperative complications. Transverse colectomy can be safely used in patients with transverse colon cancer.

Objective:To investigate the clinical efficacy of proximal gastrectomy and total gastrectomy in the treatment of Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospective cohort study was conducted. The clinicopathological data of 170 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to Guangdong Provincial People′s Hospital from January 2010 to December 2018 were collected. There were 125 males and 45 females, aged from 30 to 85 years, with a median age of 64 years. Of the 170 patients, 82 cases undergoing proximal gastrectomy were allocated into the proximal gastrectomy group and 88 cases undergoing total gastrectomy were allocated into the total gastrectomy group. Observation indica-tors: (1) surgical and postoperative situations; (2) follow-up and survival; (3) analysis of prognostic factors. Follow-up was conducted using telephone interview and outpatient examination to detect survival of patients up to December 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measure-ment data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Kaplan-Meier method was used to draw survival curves, and Log-Rank test was used for survival analysis. COX proportional hazard model was used for univariate and multivariate analyses. Variables with P<0.1 in univariate analysis were included for multivariate analysis. Results:(1) Surgical and postoperative situations. Cases with surgical approach as transthoracic or thoraco-abdominal approach, transabdominal approach, the operation time, cases with volume of intra-operative blood loss ≤100 mL or >100 mL, cases with length of proximal margin ≤1.5 cm or >1.5 cm, cases with radical surgery outcome as R 0, R 1, R 2, the number of lymph nodes harvest, cases with anastomotic leakage, cases with anastomotic stricture, cases with incision infection, cases with pleural infection or effusion, cases with abdominal infection or ascites were 61, 21, (211±18)minutes, 46, 36, 44, 38, 73, 6, 3, 15(9,22), 5, 2, 2, 4, 2 in the proximal gastrectomy group, respec-tively. The above indicators were 12, 76, (263±15)minutes, 27, 61, 45, 43, 82, 4, 2, 23(18,32), 4, 1, 3, 1, 4 in the total gastrectomy group, respectively. There were significant differences in the surgical approach, operation time, volume of intraoperative blood loss and the number of lymph nodes harvest between the two groups ( χ2=63.94, t=-25.50, χ2=11.19, Z=-5.62, P<0.05). There was no significant difference in the length of proximal margin or radical surgery outcome between the two groups ( χ2=0.11, Z=-0.95, P>0.05) and there was no significant difference in the anastomotic leakage, anastomotic stricture, incision infection, pleural infection or effusion, abdominal infection or ascites between the two groups ( P>0.05). (2) Follow-up and survival. All the 170 patients were followed up for 89(64,106)months. Of the 170 patients, the 5-year overall survival rates were 43.8% and 35.5% of the Siewert type Ⅱ and Ⅲ AEG patients, respectively, showing no significant difference between them ( χ2=0.87, P>0.05). Of the patients with Siewert type Ⅱ AEG, the 5-year overall survival rates were 41.7% and 54.3% in the patients with proximal gastrectomy and the total gastrectomy, respectively, showing no significant difference between them ( χ2=1.05, P>0.05). Of the patients with Siewert type Ⅲ AEG, the 5-year overall survival rates were 31.3% and 37.5% in the patients with proximal gastrectomy and the total gastrectomy, respectively, showing no significant difference between them ( χ2=0.33, P>0.05). The 5-year overall survival rates were 39.0% and 44.2% in the proximal gastrectomy group and the total gastrectomy group, respectively, showing no significant difference between the two groups ( χ2=0.63, P>0.05). Of the patients in TNM stage Ⅰ, stage Ⅱ, stage Ⅲ, the 5-year overall survival rates were 65.3%, 36.3%, 27.1% in the proximal gastrectomy group, versus 83.3%, 48.0%, 39.7% in the total gastrectomy group, showing no signifi-cant difference between the two groups ( χ2=0.02, 1.50, 1.21, P>0.05). (3) Analysis of prognostic factors. Results of univariate analysis showed that pathological N staging, degree of tumor differen-tiation and radical surgery outcome were related factors influencing prognosis of AEG patients ( hazard ratio=1.71, 1.70, 2.85, 95% confidence interval as 1.16-2.60, 1.15-2.50, 1.58-5.14, P<0.05). Results of multivariate analysis showed that pathological N staging and radical surgery outcome were independent factors influencing prognosis of AEG patients ( hazard ratio=1.55, 2.18, 95% confidence interval as 1.05-2.31, 1.18-4.02, P<0.05). Conclusions:There is no significant difference in the prognosis of Siewert type Ⅱ and Ⅲ AEG patients undergoing proximal gastrectomy or total gastrectomy. Proximal gastrectomy can be used for the treatment of advanced Siewert type Ⅱ and Ⅲ AEG.

Background: We aimed to investigate the association between optimal examined lymph node (ELNs) and overall survival to determine the optimal cutoff point. Methods: Cox models and locally weighted scatterplot smoothing were used to fit hazard ratios and explore an optimal cutoff point based on the Chow test. Results: Overall survival increased significantly with the corresponding increase in the number of ELNs after adjusting for covariates. In Chow's test, the optimal cutoff point for node-negative colon cancer was 15, which was validated in both cohorts after controlling for confounders (Surveillance, Epidemiology, and End Results database: hazard ratio: 0.701, p < 0.001; single-center: HR: 0.563; p = 0.031). Conclusions: We conservatively suggest that the optimal number of ELNs for prognostic stratification is 15 in node-negative colon cancer.

Background To evaluate the prognostic impact of the advanced lung cancer index (ALI) in patients with the adenocarcinoma of esophagogastric junction (AEG) after radical resection. Methods The data of patients with AEG after radical resection at Guangdong Provincial People’s Hospital from January 2008 to December 2018 were retrieved. The cutoff value of ALI was determined and the prognostic impact of clinicopathological factors and ALI were analyzed. A nomogram based on the independent prognostic factors for overall survival was then built. Results A total of 147 patients were eligible and based on a cutoff of ALI 43.1, 90 (61.2%) and 57 (38.8%) patients were classified in a low- (ALI༜43.1) and high-ALI (ALI༞43.1) group. Multivariate Cox proportional hazard analysis showed that low-ALI was associated with poor overall survival (OS) (p༜0.001, HR 2.541, 95%CI 1.408-4.410) and disease-free survival (DFS) (p=0.021, HR 1.789, 95%CI 1.020-2.674). In subgroup analysis, low-ALI was independent predictor for OS (p=0.001, HR 2.628, 95%CI 1.467-4.707) in stage III/IVA AEG patients. A nomogram for OS estimation was constructed and the C-index was 0.699 (95%CI 0.636-0.762) and the calibration plots showed satisfactory consistency between actual observation and nomogram-predicted OS probabilities. Further, satisfactory predictive accuracy for 1-, 2-, and 3-year OS rates with an area under the curve of 0.736, 0.712 and 0.697, respectively, was observed. Conclusions ALI was an independent prognostic factor for AEG patients after radical resection, and demonstrated promising ability for risk stratification of AEG, especially in advanced-stage disease.

Background: In adenocarcinoma of esophagogastric junction (AEG), the relationship between tumor size (TS) and lymph node metastasis (LNM) is unclear. This study aimed to explore the relationship between TS and LNM, and to construct a prediction model for LNM. Materials and Methods: Data from 4649 Siewert type II AEG patients were retrospectively acquired from the Surveillance, Epidemiology, and End Result (SEER) database. TS data was analyzed as a continuous variable, but also divided into 1-cm-interval categorical groups for further analysis. The logistic regression model and restricted cubic spline (RCS) model was used to explore the relationship between TS and LNM, after adjusting for covariates. Internal validations as well as external validation (Single-Center data) were used to check our LNM prediction model. Results: TS and LNM showed a significant relationship in the logistic regression analysis, regardless of the TS data being entered as a continuous or a categorical variable, after adjusting for covariates. The logistic regression model and RCS consistently showed that larger TS resulted in larger Odds Ratio (OR) values. When tumors were larger than 4 cm, the OR value remained relatively constant. The receiver operator characteristic curve evaluated the nomogram by the area under the curve (AUC) (AUC=0.737, in internal validation; AUC=0.626, in external validation), and the calibration curve of the nomogram showed an improved prediction system. Conclusions: In Siewert type II T1-T3 stage AEG patients, we reported that LNM increased with TS up to 4-cm, and our nomogram provided a simple tool to predict LNM.

目的:探讨SiewertⅡ/Ⅲ型胃食管结合部腺癌近切缘长度的临床意义.方法:收集2004年1月至2018年12月手术治疗的SiewertⅡ/Ⅲ型胃食管结合部腺癌患者的临床资料.采用X-tile软件确定近切缘长度的最佳截值;通过χ2检验、t检验进行单因素分析,logistic回归进行多因素分析,Kaplan-Meier法绘制生存曲线.结果:共纳入166例患者,其中腹腔镜组86例,开腹组80例.X-tile软件确定近切缘长度最佳截值为1.5 cm.近切缘长度≤1.5 cm的5年生存率小于近切缘长度>1.5 cm(39.5％vs.64.1％,P=0.017),差异有统计学意义;近切缘长度≤1.5 cm时,腹腔镜组与开腹组5年生存率差异无统计学意义(29.4％vs.48.3％,P=0.797);近切缘长度>1.5 cm时,腹腔镜组5年生存率大于开腹组(70.8％vs.54.1％,P=0.031),差异有统计学意义.腹腔镜组手术时间较长,但术中出血量少,清扫淋巴结数量多,术后住院时间短.单因素分析结果显示,术后T分期、术后N分期、近切缘长度是影响患者预后的危险因素(P=0.013,0.009,0.017).多因素logistic回归模型显示,近切缘长度是影响患者预后的独立危险因素(OR=3.125,95％CI:1.459-6.695,P=0.003).结论:在保证近切缘长度>1.5 cm的基础上,选择腹腔镜手术利于减少术中出血量、清扫更多的淋巴结、缩短术后住院时间.

Objective The prognostic value of lymphovascular invasion (LVI), perineural invasion (PNI), and poor differentiation (PD) has been widely studied in different solid tumors. However, it was still controversial in adenocarcinoma of esophagogastric junction (AEG). We investigated the prognostic impact of combining LVI, PNI and PD for predicting the survival in patients with AEG. Methods We retrospectively investigated the data of patients who performed surgical resection of AEG on Guangdong Provincial Hospital and Guangdong Provincial Hospital of Chinese Medicine from Jan. 2004 to Dec. 2018. According to the status of LVI, PNI and differentiation, pathological adverse features were divided into three groups: 0, 1 or 2 and 3 adverse features, their impact on prognosis was evaluated. Results Univariate analysis indicated pT, pN, LVI , PNI , PD and pathological adverse features were risk factors for both overall survival (OS) and disease-specific survival (DSS), and multivariate analysis indicated that pathological adverse feature was independent risk factor for both OS and DSS. In subgroup analyses, adverse features were independent risk factor for DSS of stage II AEG but not for stage I or III. Conclusions The pathological adverse features were independent prognostic factors for AEG patients and they can help for further risk stratification in stage II patients.

PURPOSE:Tumors with lymphovascular invasion (LVI) are thought to be associated with lymph node metastasis and to lead to a worse prognosis. However, the effect of LVI on the prognosis of adenocarcinoma of esophagogastric junction (AEG) is still unclear.PATIENTS AND METHODS:We retrospectively analyzed 224 consecutive patients with non-metastatic AEG who underwent radical surgery in our hospital from 2004 to 2018. Inverse probability weighting (IPW) analysis was used to eliminate the selection bias. IPW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare disease-specific survival (DSS) and overall survival (OS) between patients with and without LVI.RESULTS:A total of 224 patients with non-metastatic AEG who underwent radical resection were included in the study and 96 (42.9%) patients developed LVI. Survival analysis showed that LVI were associated with worse DSS (hazard ratio (HR) = 3.12; 95% CI: 1.93-5.03) and worse OS (HR = 2.33; 95% CI: 1.61-3.38). The results were consistent across subgroups stratified by pathologic N stage. Subgroup analysis demonstrated that Siewert type III (HR= 3.20, 95% CI: 1.45-7.06) was associated with worse DSS, but not Siewert type I/II (HR= 1.46, 95% CI: 0.94-2.31, P-interaction=0.047).CONCLUSION:LVI are associated with worse prognosis in AEG. LVI had a worse effect on DSS in Siewert type III AEG than Siewert type I/II AEG.