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已发表论文
探究食管胃结合部 Siewert Ⅱ型和Ⅲ型腺癌不同长度近端切缘对短期和长期预后的影响
Authors Liu G, Hao C, Zhang Y, Qi S, Li F, Bian J, Zhang C, Liu W
Received 16 July 2025
Accepted for publication 22 October 2025
Published 7 November 2025 Volume 2025:17 Pages 2643—2651
DOI https://doi.org/10.2147/CMAR.S554260
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
Editor who approved publication: Professor Yong Teng
Guangchao Liu, Chen Hao, Yao Zhang, Shuai Qi, Feng Li, Jing Bian, Cuisha Zhang, Wei Liu
Department of General Surgery, Bethune International Peace Hospital, Shijiazhuang, Hebei, People’s Republic of China
Correspondence: Wei Liu, Department of General Surgery, Bethune International Peace Hospital, No. 398 Zhongshan West Road, Qiaoxi District, Shijiazhuang, Hebei, 050051, People’s Republic of China, Tel +86-13933003648, Email talismanliu@163.com
Introduction: The optimal proximal margin length for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEJ) remains debated. This study aimed to evaluate the effect of different proximal margin lengths on short- and long-term prognosis.
Methods: In this retrospective study, clinical data from patients undergoing surgery for Siewert type II/III AEJ between January 2019 and January 2024 were collected. Patients were stratified into three groups based on the length of the proximal margin (0.5– 2 cm, 2– 4 cm, and > 4 cm). Short-term outcomes, including R0 resection rates and complications, along with long-term survival (OS and PFS), were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to assess prognostic impacts.
Results: A total of 173 patients were included (0.5– 2 cm, n=57; 2– 4 cm, n=60; > 4 cm, n=56). The 0.5– 2 cm group had significantly higher R1 resection (12.28% vs 1.67%/0%) and anastomotic recurrence rates but a lower anastomotic leak incidence compared to the other groups (P< 0.05). The > 4 cm group showed longer operative times and higher leak rates. Survival analysis revealed poorer overall survival (OS) and progression-free survival (PFS) for the 0.5– 2 cm group versus other groups (P< 0.05), with no significant difference between the 2– 4 cm and > 4 cm groups. Cox regression confirmed that a margin length > 2 cm reduced progression risk (HR=0.793, 95% CI 0.641– 0.981, P=0.033), particularly for tumors < 4 cm, Siewert type II, and intestinal-type Lauren classification.
Conclusion: A 2– 4 cm proximal margin appears to optimize the prognosis in Siewert type II/III AEJ, balancing oncologic safety and surgical outcomes. This margin length is especially beneficial for tumors < 4 cm, Siewert II classification, and intestinal-type histology. A personalized surgical strategy is recommended.
Keywords: adenocarcinoma of esophagogastric junction, siewert II/III, proximal margin length, prognosis, survival analysis
Department of General Surgery, Bethune International Peace Hospital, Shijiazhuang, Hebei, People’s Republic of China
Correspondence: Wei Liu, Department of General Surgery, Bethune International Peace Hospital, No. 398 Zhongshan West Road, Qiaoxi District, Shijiazhuang, Hebei, 050051, People’s Republic of China, Tel +86-13933003648, Email talismanliu@163.com
Introduction: The optimal proximal margin length for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEJ) remains debated. This study aimed to evaluate the effect of different proximal margin lengths on short- and long-term prognosis.
Methods: In this retrospective study, clinical data from patients undergoing surgery for Siewert type II/III AEJ between January 2019 and January 2024 were collected. Patients were stratified into three groups based on the length of the proximal margin (0.5– 2 cm, 2– 4 cm, and > 4 cm). Short-term outcomes, including R0 resection rates and complications, along with long-term survival (OS and PFS), were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to assess prognostic impacts.
Results: A total of 173 patients were included (0.5– 2 cm, n=57; 2– 4 cm, n=60; > 4 cm, n=56). The 0.5– 2 cm group had significantly higher R1 resection (12.28% vs 1.67%/0%) and anastomotic recurrence rates but a lower anastomotic leak incidence compared to the other groups (P< 0.05). The > 4 cm group showed longer operative times and higher leak rates. Survival analysis revealed poorer overall survival (OS) and progression-free survival (PFS) for the 0.5– 2 cm group versus other groups (P< 0.05), with no significant difference between the 2– 4 cm and > 4 cm groups. Cox regression confirmed that a margin length > 2 cm reduced progression risk (HR=0.793, 95% CI 0.641– 0.981, P=0.033), particularly for tumors < 4 cm, Siewert type II, and intestinal-type Lauren classification.
Conclusion: A 2– 4 cm proximal margin appears to optimize the prognosis in Siewert type II/III AEJ, balancing oncologic safety and surgical outcomes. This margin length is especially beneficial for tumors < 4 cm, Siewert II classification, and intestinal-type histology. A personalized surgical strategy is recommended.
Keywords: adenocarcinoma of esophagogastric junction, siewert II/III, proximal margin length, prognosis, survival analysis