AbstractBackgroundThis study compared the survival outcomes of different surgical approaches to determine the optimal approach for gastric cardia adenocarcinoma (GCA) and aimed to standardize the surgical treatment guidelines for GCA.MethodsA total of 7103 patients with GCA were enrolled from our previously established gastric cardia and esophageal carcinoma databases. In our database, when the epicenter of the tumor was at or within 2 cm distally from the esophagogastric junction, the adenocarcinoma was considered to originate from the cardia and was considered a Siewert type 2 cancer. The main criteria for the enrolled patients included treatment with radical surgery, no radio- or chemotherapy before the operation, and detailed clinicopathological information. Follow-up was mainly performed by telephone or through home interviews. According to the medical records, the surgical approaches included transthoracic, thoracoabdominal, and transabdominal approaches. Kaplan–Meier and Cox proportional hazards regression models were applied to correlate the surgical approach with survival in patients with GCA.ResultsThere were marked differences in age and tumor stage among the patients who underwent the three surgical approaches (P < 0.001). Univariate analysis showed that survival was related to sex, age, tumor stage, and N stage (P < 0.001 for all). Cox regression model analysis revealed that thoracoabdominal approach (P < 0.001) and transabdominal approach (P < 0.001) were significant risk factors for poor survival. GCA patients treated with the transthoracic approach had the best survival (5-year survival rate of 53.7%), and survival varied among the different surgical approaches for different tumor stages.ConclusionThoracoabdominal approach and transabdominal approach were shown to be poor prognostic factors. Patients with (locally advanced) GCA may benefit from the transthoracic approach. Further prospective randomized clinical trials are necessary.

目的 评估上消化道黏膜病变及早期癌术前胃镜活体组织检查(简称活检)病理结果和内镜黏膜下剥离术(ESD)术后病理结果的一致性.方法 选取磁县人民医院2017-07-01-2018-06-30胃镜活检病理诊断为上消化道癌前病变及早期癌并行ESD治疗的50例患者为研究对象.对比分析其术前胃镜病理结果与术后ESD病理结果的差异.结果 50例患者,术前活检病理为上皮内瘤变43例,其中低级别上皮内瘤变1例,高级别上皮内瘤变42例(病灶45处);早癌7例.术后最终病理为高级别上皮内瘤变33例;早癌17例(病灶19处),其中黏膜内癌9例(11处病灶).术前活检病理与术后病理诊断符合率为76.9％(40/52),术后病理程度较术前病理严重的占23.1％(12/52),分别占各活检比例的71.1％(32/45)和100.0％(7/7).早癌组活检与术后病理诊断符合率高于上皮内瘤变组,差异有统计学意义,P＜0.05.结论 术前活检病理与术后切除病理结果存在一定差异,术前病理结果对诊断有较好的提示价值,但不能完全代表整个病灶病变程度,对于上皮内瘤变及早期癌应结合内镜给予ESD治疗,在获得准确诊断的同时对病灶早期切除.

目的 建立一种联合检测MDM2、BRCA2和MGMT自身抗体的食管癌高危人群筛查ELISA试剂盒,并探讨其在大规模无症状人群中的推广价值.方法 利用间接酶联免疫吸附试验对食管癌组和对照组进行相关血清自身抗体检测,比较其表达差异;在食管癌高发区对无症状人群行血清学检测,且对所有受试者行色素内镜检测,比较检测结果;在食管癌高发区对大规模无症状人群进行筛查,并对血清学检查阳性受试者行色素内镜检查,了解早期癌检出情况.结果 3种食管癌相关自身抗体联检食管癌患者阳性率比对照组升高8.52倍(89.50％VS 10.50％),敏感度和特异度均为89.50％;对高发区403例无症状人群3种自身抗体联合检测发现,阳性90例(22.25％);进一步对403人全部行色素内镜和黏膜活检发现,自身抗体阳性组食管癌和癌前病变数量显著多于阴性组;自2011年起对河北磁县地区19415例无症状人群进行食管癌筛查,共发现3980例高易感人群(20.50％);对3980例高危人群进一步行色素内镜和黏膜活检病理检查,共发现1553例癌前病变(39.02％);504例早期食管癌(12.67％).结论 MDM2、BRCA2和MGMT这3种食管癌血清自身抗体联合的ELISA试剂盒,可以更精确筛出无症状的高危人群和早期癌,降低内镜筛查人数、筛查成本,可在食管癌高发区大规模推广应用.

在日常生活当中,人们喜欢食用一些山楂及黑枣等食物,部分未成熟的食物当中含有高量的鞣酸,人食用后会和蛋白质结合成鞣酸蛋白并大量沉积于胃中得不到及时的排空,久而久之就会形成胃石.近年来胃石症患者数量逐渐增高,尤其是在秋冬季节该病有着更高的发病几率.基于此,本文以我院2019年10月份-2020年4月份所接诊的45名胃石症患者为例,探讨分析了药物与胃镜综合治疗胃石的方法.

Objective:To summarize and analyze the endoscopic screening results of 8,149 asymptomatic patients. Methods:Endoscopic screening data of high-risk people aged 40-69 in Ci county from 2011 to 2013 were reviewed, and the detection rate of upper gastrointestinal cancer and its precancerous lesions and treatment success rate of positive cases in different genders and ages were calculated. Results:A total of 8,149 cases were included in the analysis, inclu-ding 3,424 males and 4,725 females, with a male to female ratio of 0. 72∶1. In total, 174 positive cases were detected, with a detection rate of 2. 14% (109 males, detection rate:3. 18% ;65 females, detection rate:1. 38% ). The early diagnosis rate was 91. 38% , the treatment success rate of 86. 21% , and the treatment success rate of endoscopy was 48. 43% . Among the 174 patients aged 44-70 years (average 60 years), 109 were males and 65 were females, with a male to female ratio of 1. 68∶1. In all cases of upper gastrointestinal cancer, the proportion of patients aged 60 -64 was the highest (35. 06% , 61／174), followed by those aged 55 -59 (27. 01% , 47／174) and 65-69 (20. 11% , 35／174), respectively. A total of 111 positive cases were detected in esopha-gus (63. 79% , 111／174), 42 in cardia (24. 14% , 42／174), and 21 in stomach (12. 07% , 21／174). Conclusion:There are a large number of asymptomatic 40-69-year-olds with upper gastrointestinal cancer and precancerous lesions in Ci Coun-ty where the incidence of esophageal cancer is high. The detection rate is closely related to gender and age. Endoscopic screening for high-risk population can effectively detect upper gastrointestinal cancer and its precancerous lesions from an ear-ly stage, and reduce the incidence and mortality of upper gastrointestinal cancer through timely intervention and treatment.

Objective:To investigate the occurrence of upper gastrointestinal cancer and precancerous lesions in asympto-matic population in Ci County. Methods:From 2005 to 2018, People's Hospital of Ci County carried out gastroscopy for 27,994 asymptomatic people aged 40-69 in 7 villages in Ci County. Lesion biopsy was taken for pathological examination and diagnosis. Results:The number of new cases of esophageal cancer, gastric cardia cancer and gastric cancer were 243, 95 and 26, that of those cancers' precancerous lesions were 2,819, 345 and 213, and that of early esophageal cancer, gas-tric cardia cancer and gastric cancer were 194, 56 and 20, which accounting for 83% , 59% and 77% of their corresponding cancers. Esophageal cancer and gastric cardia cancer accounted for 92. 7% of upper gastrointestinal cancers in this area. Conclusion:Esophageal cancer and gastric cardia cancer are upper gastrointestinal cancers that seriously threaten the physi-cal and mental health of people in this region. Endoscopic screening of asymptomatic population, which is an important measure for cancer prevention in the region, has greatly improved the early diagnosis and treatment of upper gastrointestinal cancers.

目的 消化道早期癌内镜诊疗逐渐受到重视,对消化道癌前病变及早期癌的治疗产生了深远影响.找寻安全有效的治疗方式是目前临床对早期癌及癌前病变患者的研究热点.本研究总结近年来本中心内镜下治疗的500例癌前病变及早期癌病例资料,评估内镜治疗上消化道黏膜病变的有效性和安全性.方法 回顾性分析2011-07-01-2018-12-31磁县人民医院28例采用氩离子凝固术(argon plasma coagulation,APC)、22例采用多环套扎黏膜切除术(multi-band mucosectomy,MBM)、350例采用黏膜切除术(endoscopic mucosalresection,EMR)和100例采用黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的上消化道黏膜病变患者的临床资料,并对比分析4种方法在病灶大小、手术时间、并发症、随访结果及成本效益方面的差异.结果 ESD组直径大小为(8.0±5.0)cm、MBM和EMR组为(5.0±2.0) cm,APC组为(3.0±1.5) cm;ESD组手术时间为(120±20) min,MBM和EMR组为(30±15) min,APC组为(20±10) min;ESD组病灶完全消除率为99.00％(99/100),MBM组为95.45％(21/22),EMR组为94.29％ (330/350);ESD组术后出血及穿孔并发症发生率为5.00％(5/100),EMR组为0.57％(2/350),P=0.002;MBM组和APC组未出现出血及穿孔等并发症;术后随访复查ESD组和MBM组未见局部复发,EMR组局部复发率为4.29％(15/350),APC组复发率为10.71％(3/28),P=0.124;ESD组手术成本为6 500元/例,MBM组为3 800元/例,EMR组为3 850元/例,APC组为650元/例.结论 对于直径≤3.0 cm而内镜下评估位于黏膜层的病灶,应用MBM、EMR和APC的方法均可以有效消除病灶,并缩短手术时间,降低医疗费用.而对于直径＞3.0 cm和经过内镜评估病变较深或多次活检后内镜下注射抬举不良的病灶,宜采取ESD的手术方式.

目的 探讨1973-2005年食管癌手术治疗患者5年生存率的变化规律及影响生存期的关键因素.方法 通过家访和(或)电话问卷调查、生存随访及住院病历复核和临床病理信息采集等,按照首次确诊时间,将这些患者等分为三个时间段,每个时间段11年(1973-1983、1984-1994、1995-2005).采用卡方检验分析三个11年间磁县医院手术治疗的食管癌患者性别、年龄和临床病理特征的分布,采用寿命表法计算三个时间段5年生存率,利用Kaplan-Meier生存曲线和Log rank检验及Cox生存分析模型分析三个时间段食管癌患者生存率变化和主要影响因素.结果 成功随访3 160例(96.7％)食管癌患者,其中第一时间段984例(31.1％);第二时间段1101例(34.9％);第三时间段1 075例(34.0％).三个时间段患者的生存率依次明显提高,5年生存率分别是8％、15％和41％ (P=1.2E-77).第二和第三个时间段中同一病理分期的患者比较,Tis+Ti(早期)和T2期患者5年生存率无显著差异,T3+T4期患者(中晚期)第三个时间段明显高于第二个时间段(P=7.0E-7);均为淋巴结转移阳性的患者,5年生存率明显提高(P=1.5E-13).Cox回归模型分析提示:性别、淋巴结转移、病变部位和残端癌阳性是影响食管癌预后的独立因素.结论 1973至2005年间食管癌患者总体5年生存率明显提高.三个时间段均为淋巴结转移阳性和中晚期的患者,其5年生存率也明显提高.性别、淋巴结转移、病变部位和残端癌阳性是影响食管癌预后的独立因素.

目的 探讨高、低发区食管癌患者淋巴结转移影响因素及其对生存期的影响,并对新版食管癌TNM分期进行评价.方法 通过入户或电话问卷调查进行生存随访,采用卡方检验、二元Logistic回归,Kaplan-Meier生存曲线和Log rank检验及Cox生存分析模型,分析高、低发区食管癌患者淋巴结转移影响因素及与生存期的关系.结果 淋巴结转移阳性食管癌患者(n=5 621)的生存期明显低于转移阴性患者(n=7 945)(P=1.9E-162),N1、N2和N3级食管癌患者生存期依次明显降低(P=4.2E-20).在淋巴结转移阳性率上,高发区患者明显高于低发区(P=1.4E-5),但生存期却优于低发区(P=1.7E-39);青年食管癌患者(≤50岁)略高于中老年患者(＞50岁)(P=0.003),而生存期显著优于中老年患者(P=2.3E-31);下段食管癌显著高于中段和上段(P=8.6E-24),而生存期则明显优于中段和上段(P=0.03).多因素分析,高低发区、性别、诊断年龄、肿瘤部位、分化和浸润程度是影响食管癌患者淋巴结转移和生存期的独立因素,N1、N2和N3级患者生存期差的风险值依次升高(HRN1=1.8,HRN2=2.5,HRN3=2.7).结论 淋巴结转移阳性患者生存期显著差于转移阴性的患者;随着淋巴结转移个数增多,食管癌患者生存期明显降低;高发区患者整体生存期优于低发区患者.

Aim:To study the influence of AHDC1 genetic variation and changes in clinicopathology on survival of esophageal cancer(EC)patients from the high- and low-incidence areas,and to highlight the molecular mechanism of EC prognosis.Methods:Home interview,questionnaire,telephone follow-up and hospital pathology verification were applied to get the clinical pathology and survival data of 3 478 cases of EC.Fasting peripheral blood samples were collected for each patient.The Taqman method was used to detect the variation of rs4908343 locus on AHDC1 gene.Results:Five-year survival rate of the patients with AA/AG genotypes of AHDC1 was higher than those with GG genotype(χ2=6.650,P=0.010).The patients with superficial infiltration,without lymph node metastasis,at early stage,accepted surgery,or living in high-incidence area of EC had higher 5-year survival rate(χ2=52.756,39.087,61.314,75.635,175.205,P0.05).Cox multivariable analysis showed that GG genotype of AHDC1,advanced stage,and low-incidence area were the independent prognostic factors for EC patients(P0.05).Conclusion:Cenotype of AHDC1 gene,clinical stage and high- and low-incidence area are important factors affecting the prognosis of EC patients.

Objective The present study aimed to compare the gross biological characteristics of tumor from patients of the four kinds of esophageal cancer at middle and advanced stage and the influence on the survival in order to further shed light on the key prognostic factors for EC.Methods The questionnaire,home interview and/or telephone interview were performed for survival follow-up on ESCC patients,and check the clinical information of ESCC patients in hospitals.The Chi square test,Kaplan-Meier survival analysis,Log-rank test and multivariate Cox regression model were applied to the comparison.Results The followup was successfully made in 9672cases(92.9%).The survival time in patients of fungating type was significantly longer than that in patients with medullary,ulcerating,and constriction types(P<0.005).The constituent ratio for four kinds of gross tumor types at middle and advanced stages was significantly different respectively in high and low incidence areas,male and female gender,youth(≤50)and older(> 50)patients(P<0.05).The constituent ratio for four kinds of gross tumor types at middle and advanced stages was significantly different respectively in tumor location(upper,middle and lower segment),tumor differentiation,number of positive lymph nodes,and tumor invasion(P<0.05).It was noteworthy that the ratio of fungating type patients with well differentiation was higher than that of other three types,but the ratio with two or more positive lymph nodes and at T3+ T4-stage was less than those of the other three types.Multivariate regression analysis showed that,tumor gross types was not independent factors for survival of patients with EC at middle and advanced stage.Conclusion The ratio of fungating type patients with well differentiation was higher than that of other three types,but,the ratio with two or more positive lymph nodes and at T3+ T4stage was less than those of the other three types.The survival of fungating type patients was the best.Tumor gross type was not independent factors for survival of patients with advanced EC.

Aim:To detect the expressions of 23 kinds of cancer-related protein and their relation with clinical pathological changes in 679 cases of esophageal squamous cell carcinoma(ESCC),and to further understand the molecular basis for ESCC prognosis.Methods:Six hundred and seventy nine ESCC samples were surgically resected tissue.The expressions of 23 kinds of cancer-related protein,including Fascin, Syn,P63,et al were detected by immunohistochemical method.The relationship between the expressions of 23 kinds of protein and clinical pathological changes was analyzed.Results:Out of the 23 kinds of cancer-related protein,AE1/AE3, P63, CK5/6, CK, Ki67 and MUC1 (≥80%) had relatively higher positive expression rate in ESCC tissue,while CD56, CTTN, Syn, S100, CgA and CK20 (≤30%) had relatively lower positive expression rate.Syn expression was higher in metastasis tissue than in non-metastasis tissue(χ2=4.167,P=0.041),CD56 expression was higher in poorly differentiated tissue than in high and moderate differentiated tissue (P=0.017),and Ki67 expression was higher in advanced stage than in early stage (χ2=6.596,P=0.010). In contrast,P63 expression was higher in ESCC tissue without metastasis (χ2=5.095,P=0.024),the expressions of E-cad, Fascin, Ezrin,and PLK1 were higher in high and moderate differentiated tissue (P0.05),and Vim and CTTN protein expression was higher in early stage than in advanced stage(P0.05).Conclusion:The higher expressions of Syn, CD56 and Ki67 may be important candidates for ESCC with poor prognosis. However, the higher expressions of P63, E-cad, Fascin, Ezrin, PLK1, Vim, and CTTN may be important candidates for ESCC with better prognosis.

[目的]探讨影响食管癌早诊早治普查顺应性的因素。[方法]分析2005～2010年磁县食管癌早诊早治胃镜普查中影响顺应性的因素。 [结果]2005～2010年磁县食管癌早诊早治胃镜普查顺应性明显提高。抓住普查时机、消除社会恐惧心理、行政干预、强化舒适内镜概念为提高普查顺应性要素。[结论]进一步做好宣传发动工作，抓住普查时机，强化舒适内镜概念是提高顺应性的关键。

[目的]探讨食管/贲门双源癌的临床病理特征.[方法]采用问卷调查、家访、医院病案资料整理分析及病理学检查等方法,对豫北地区及河北磁县的双源癌患者资料进行收集整理.首次诊断的双源癌患者431例,另检出漏诊双源癌112例,共543例.[结果]双源癌男:女=5.12:1,高发年龄60～70岁.双源癌中食管癌和贲门癌均以Ⅱ期居多(55.56%、36.17%):食管癌以中分化为主(62.81%),而贲门癌以低分化为主(48.41%);食管癌发病部位以中段居多(66.67%);食管癌以髓质型和早期癌比例最高(均为33.07%),贲门癌以蕈命型f29.92%1居多..双源癌家族史阳性率40.13%,男性高于女性(43.18%vs20.00%,P=0.049).5年生存率17.54%.[结沦]食管/贵门双源癌漏诊率高,发病以男性为主.5年生存率较低.

Li Dong Wang and colleagues report a genome wide association study for esophageal squamous cell carcinoma in the Chinese population. They identify two risk loci at PLCE1 and C20orf54 .

Objective To identify prognostic factors in patients with esophageal cancer after curative resection.Methods 971 patients operated on for neoplasia of the esophagus,who underwent a curative resection were included in this study.14 variables were studied by univariate analysis.The variables linked with survival were include in a Cox model and then prognostic index(PI) was calculated.Cumulative surviva of the entire population was computed by Life table analysis.Results Cumulative survival at 3 and 5 years was 78.29%,68.81%,respectively and median survival was 97.49 months.In univariate analysis,10 out of 14 factors were statistically linked with survival.In multivariate analysis(Cox model),5 independent factors were linked with survival which included:clinical stage,location of tumor,differentiation of tumor,depth of invasion and number of node metastases.Conclusion Cumulative survival at 3,5 years was relatively high.According to the Wald value,clinical stage was the major prognostic factor affecting the survival of patients with esophageal carcinoma.