Abstract：
BACKGROUND: The optimal proximal margin (PM) length for Siewert II/III adenocarcinoma of the esophagogastric junction (AEJ) remains unclear. This study aimed to determine the optimal PM length using an abdominal approach to guide surgical decision-making.
METHODS: A prospective study analyzed 304 consecutive patients diagnosed with Siewert II/III AEJ between January 2019 and December 2021. Total gastrectomy was performed via the abdominal approach, and PM length was measured on fixed gross specimens. X-Tile software determined the optimal PM cut-point based on progression-free survival (PFS). Univariate analyses compared baseline characteristics across PM groups, while survival analyses utilized Kaplan-Meier estimation and Cox proportional hazards regression for assessing the impact of margin length on survival. Multivariable analyses were conducted to adjust for confounding variables.
RESULTS: The study included 264 AEJ cases classified as Siewert II (71.97%) or III (28.03%). The median gross PM length was 1.0 cm (IQR: 0.5 cm-1.5 cm, range: 0 cm-6 cm). PM length ≥1.2 cm was associated with a lower risk of disease progression compared to PM length 0.4 cm on PFS (HR = 0.41, 95% CI 0.20-0.84, P = 0.015). Moreover, PM ≥ 1.2 cm improved prognosis in subgroups of T4 or N3, tumor size <4 cm, Siewert II, and Lauren classification.
CONCLUSIONS: For Siewert type II/III AEJ, a proximal margin length ≥1.2 cm (1.65 cm in situ) is associated with improved outcomes. These findings offer valuable insights into the association between PM length and outcomes in Siewert II/III AEJ, providing guidance for surgical approaches and aiding clinical decision-making to enhance patient outcomes.
METHODS: A prospective study analyzed 304 consecutive patients diagnosed with Siewert II/III AEJ between January 2019 and December 2021. Total gastrectomy was performed via the abdominal approach, and PM length was measured on fixed gross specimens. X-Tile software determined the optimal PM cut-point based on progression-free survival (PFS). Univariate analyses compared baseline characteristics across PM groups, while survival analyses utilized Kaplan-Meier estimation and Cox proportional hazards regression for assessing the impact of margin length on survival. Multivariable analyses were conducted to adjust for confounding variables.
RESULTS: The study included 264 AEJ cases classified as Siewert II (71.97%) or III (28.03%). The median gross PM length was 1.0 cm (IQR: 0.5 cm-1.5 cm, range: 0 cm-6 cm). PM length ≥1.2 cm was associated with a lower risk of disease progression compared to PM length 0.4 cm on PFS (HR = 0.41, 95% CI 0.20-0.84, P = 0.015). Moreover, PM ≥ 1.2 cm improved prognosis in subgroups of T4 or N3, tumor size <4 cm, Siewert II, and Lauren classification.
CONCLUSIONS: For Siewert type II/III AEJ, a proximal margin length ≥1.2 cm (1.65 cm in situ) is associated with improved outcomes. These findings offer valuable insights into the association between PM length and outcomes in Siewert II/III AEJ, providing guidance for surgical approaches and aiding clinical decision-making to enhance patient outcomes.
摘要：
背景：SiewertII/III型食管胃结合部腺癌（AEJ）的最佳近端边缘（PM）长度尚不清楚。本研究旨在使用腹部入路确定最佳PM长度，以指导手术决策。
方法：一项前瞻性研究分析了2019年1月至2021年12月期间诊断为SiewertII/IIIAEJ的304例连续患者。通过腹部入路进行全胃切除术，PM长度是在固定的总标本上测量的。X-Tile软件基于无进展生存期(PFS)确定最佳PM切点。单变量分析比较了PM组的基线特征，而生存分析利用Kaplan-Meier估计和Cox比例风险回归评估边缘长度对生存的影响.进行多变量分析以调整混杂变量。
结果：该研究包括264例AEJ病例，分类为SiewertII（71.97%）或III（28.03%）。PM总长度中位数为1.0厘米（IQR：0.5厘米-1.5厘米，范围：0厘米-6厘米）。在PFS上，PM长度≥1.2cm与PM长度0.4cm相比，疾病进展风险较低（HR=0.41，95％CI0.20-0.84，P=0.015）。此外，PM≥1.2cm改善T4或N3亚组的预后，肿瘤大小<4cm，SiewertII,和劳伦分类。
结论：对于SiewertII/III型AEJ，近端边缘长度≥1.2cm(原位1.65cm)与结局改善相关.这些发现为SiewertII/IIIAEJ中PM长度与结果之间的关联提供了有价值的见解，为手术方法提供指导并帮助临床决策以提高患者预后。
方法：一项前瞻性研究分析了2019年1月至2021年12月期间诊断为SiewertII/IIIAEJ的304例连续患者。通过腹部入路进行全胃切除术，PM长度是在固定的总标本上测量的。X-Tile软件基于无进展生存期(PFS)确定最佳PM切点。单变量分析比较了PM组的基线特征，而生存分析利用Kaplan-Meier估计和Cox比例风险回归评估边缘长度对生存的影响.进行多变量分析以调整混杂变量。
结果：该研究包括264例AEJ病例，分类为SiewertII（71.97%）或III（28.03%）。PM总长度中位数为1.0厘米（IQR：0.5厘米-1.5厘米，范围：0厘米-6厘米）。在PFS上，PM长度≥1.2cm与PM长度0.4cm相比，疾病进展风险较低（HR=0.41，95％CI0.20-0.84，P=0.015）。此外，PM≥1.2cm改善T4或N3亚组的预后，肿瘤大小<4cm，SiewertII,和劳伦分类。
结论：对于SiewertII/III型AEJ，近端边缘长度≥1.2cm(原位1.65cm)与结局改善相关.这些发现为SiewertII/IIIAEJ中PM长度与结果之间的关联提供了有价值的见解，为手术方法提供指导并帮助临床决策以提高患者预后。
