Page 75 - 南京医科大学自然版

第45卷第7期 南京医科大学学报（自然科学版）
2025年7月 Journal of Nanjing Medical University（Natural Sciences） ·973 ·

·临床研究·

早期Siewert Ⅱ型食管胃结合部腺癌患者ESD及外科治疗术后

生存预后比较

郁 馨，杨若云，陈 涵，周晓颖，张国新 *

南京医科大学第一附属医院消化内科，江苏 南京 210029

［摘 要］ 目的：评估早期Siewert Ⅱ型食管胃结合部腺癌（adenocarcinoma of esophagogastric junction，AEGJ）患者接受内镜黏
膜下剥离术（endoscopic submucosal dissection，ESD）与根治性手术的长期生存结局差异。方法：回顾性分析2010年1月—2021年
2月于单中心三级医疗中心接受治疗的562例早期Siewert Ⅱ型AEGJ患者，其中接受ESD治疗393例，根治性手术治疗169例。通
过倾向评分匹配（propensity score matching，PSM）平衡基线特征后，采用 Kaplan⁃Meier 法评估早期 Siewert Ⅱ型 AEGJ 患者 ESD
和外科手术的生存差异。结果：562 例患者的中位随访时间为 57.7 个月（范围 6.2~147.0 个月）。经过 PSM 后生成了 2 个平衡
组，每组包含163例患者。ESD组和手术组的5年总生存率差异无统计学意义（92.5% vs. 90.7%，P=0.734）。两组患者的总生存
期（P=0.95）、疾病特异性生存期（P=0.18）差异均无统计学意义。不良事件分析显示，两组在淋巴结转移（6.7% vs. 7.4%，P=
0.829）、局部复发（4.9% vs. 9.2%，P=0.130）、术后狭窄（3.7% vs. 1.2%，P=0.152）及出血（1.2% vs. 0.6%，P=0.562）方面不存在统计
学差异，但手术组的反酸症状发生率更高（11.0% vs. 3.1%，P=0.005）。结论：ESD 与手术治疗早期SiewertⅡ型AEGJ 的长期生
存结局相似，提示ESD可作为该人群的有效替代治疗方案。
［关键词］ 食管胃结合部腺癌；生存预后；内镜黏膜下剥离术；手术
［中图分类号］ R735.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）07⁃973⁃11
doi：10.7655/NYDXBNSN250311

Comparison of postoperative survival outcomes between endoscopic submucosal

dissection and surgical treatment in patients with early Siewert typeⅡadenocarcinoma of
the esophagogastric junction
*
YU Xin，YANG Ruoyun，CHEN Han，ZHOU Xiaoying，ZHANG Guoxin
Department of Gastroenterology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：To compare the long⁃term prognosis of endoscopic submucosal dissection（ESD）versus surgical treatment in
patients with early Siewert type Ⅱ adenocarcinoma of the esophagogastric junction（AEGJ）. Methods：A retrospective analysis was
conducted on 562 patients with early Siewert type Ⅱ AEGJ who underwent ESD or radical surgery at a single tertiary medical center
between January 2010 and February 2021，including 393 cases treated with ESD and 169 cases treated with radical surgery. After
balancing baseline characteristics using propensity score matching（PSM），the Kaplan⁃Meier analysis was used to compare long⁃term
survival outcomes between ESD and surgical treatment. Results：The median follow⁃up time for all 562 patients was 57.7 months
（range 6.2-147.0 months）. After PSM，two balanced cohorts of 163 patients each were generated. The 5⁃year overall survival（OS）
rates showed no significant difference between the ESD and surgery groups（92.5% vs. 90.7% ，P=0.734）. Similarly，no significant
differences were observed in OS（P=0.95）or disease⁃specific survival（P=0.18）between the two groups. The analysis of adverse events
showed no significant differences between the two groups in lymph node metastasis（6.7% vs. 7.4%，P=0.829），local recurrence（4.9%
vs. 9.2%，P=0.130），postoperative stenosis（3.7% vs. 1.2%，P=0.152），or bleeding（1.2% vs. 0.6%，P=0.562）. However，the incidence
of acid reflux symptoms was significantly higher in the surgery group（11.0% vs. 3.1% ，P=0.005）. Conclusion：ESD and surgical
treatment for early ⁃ stage Siewert type Ⅱ AEGJ demonstrate similar long ⁃ term survival outcomes，suggesting that ESD can be an

［基金项目］ 国家自然科学基金（81970499）
通信作者（Corresponding author），E⁃mail：guoxinz@njmu.edu.cn（ORCID：0000⁃0002⁃7531⁃0404）
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