编者按：2024年9月22~24日，第20届世界食管疾病大会（ISDE）在苏格兰爱丁堡盛大召开。里斯本肿瘤研究中心Filipa Fonseca教授一项关于改良的胃食管交界处（EGJ）Siewert分类法入选大会Late-Breaking口头报告摘要展示（摘要号：LB-OA02.07），引起了广泛交流与热烈讨论。《肿瘤瞭望消化时讯》在大会现场针对该分类方法对Filipa Fonseca教授进行了专访。现将专访内容进行了整理，并附上相关研究摘要，以供大家参考。

肿瘤瞭望消化时讯：能否请您谈谈原版Siewert分类的主要局限性或者您进行修订想要解决哪些问题吗？

Oncology Frontier: Your revised approach to the esophagogastric junction with a modified Siewert classification aims to address specific challenges in classification. Can you elaborate on the main limitations of the original Siewert classification and how your modifications address these issues?

Dr. Filipa Fonseca：As you are aware, the Siewert classification was initially proposed in 1987, and it relies on the definition of the EG junction, but also on the tumor epicenter. And the definition of the tumor epicenter can be subjective and also inconsistent. So this prompts us to really, I think that we are talking about the same tumors when we talk, for example, about the Siewert tumor. That can be just a Siewert Ⅱ, but also has its esophageal involvement and gastric involvement. So really, Siewert Ⅱ tumors can be super different, and the Siewert classification does not really have an implication of the resection margins and also on the lymph node dissection extension.

Filipa Fonseca教授

肿瘤瞭望消化时讯：您修改后的Siewert分类与原版有什么不同？您预计这些变化将如何影响食管胃交界处腺癌患者的临床决策和治疗结果？

Oncology Frontier: In your modified Siewert classification, what are the key criteria that differentiate the revised classification from the original one? How do you anticipate these changes will impact clinical decision-making and treatment outcomes for patients with esophagogastric junction tumors?

Dr. Filipa Fonseca：Our modified Siewert classification relies on three endoscopic measurements. The endoscopic EG junction, as is classified in the Japanese guidelines, but also on the proximal and distal limits.So we have a classification that truly reflects the full extension of the tumor and its relationship with the EGJ junction and not only the epicenter. So we think that these classifications really manifest in the choice of surgery and the extension of the resection, but also on the definition of the lymph node dissection that should be done in that particular case.

肿瘤瞭望消化时讯：您修订的Siewert分类如何与当前的治疗指南和多学科管理方法相结合？在处理食管胃交界处腺癌的特定案例或场景中，这一修订分类是否提供了比现有分类更显著的优势？

Oncology Frontier: How does your modified Siewert classification integrate with current treatment guidelines and multidisciplinary approaches for managing esophagogastric junction tumors? Are there specific cases or scenarios where this revised classification offers significant advantages over existing classifications?

Filipa Fonseca教授：这个分类体系应当会被纳入当前的指南之中，因为它精确地展现了肿瘤的全貌。它不仅会指导我们选择适当的切除范围和淋巴结清扫范围，还会深刻影响每位外科医生的治疗决策。展望未来，这一分类体系有望提升EGJ腺癌的R0切除率、降低局部区域转移率，并改善患者的总体生存率。在我们的研究和展示的海报中，您可以找到更多细节，包括具体案例和这一分类如何改变了我们的治疗策略。我们期待它未来也能对您的临床实践产生积极影响。

Oncology Frontier: So, yes, this classification could be integrated in the current guidelines, because actually it's a reflection of the full extension of the tumor.

So it will reflect on the choice of resection extension and also on the lymph node dissection extension. So really its implication on the choice that everyone, every surgeon makes. And its future implications will be on the R0 resection margins rates, and also in the local regional metastasis rate, and also on the overall survival of these patients. And you can see our work and our poster with more detailed information about the specific examples and which this classification changed our approach, and hopefully in the future, your approach too.

研究简介

背景

EGJ腺癌因其独特的解剖和病理特征，在治疗上常被视为食管癌或胃癌的一部分，处理起来颇具挑战性。Siewert（S）和Nishi分类法主要依据肿瘤中点位置来指导治疗决策，但这可能导致诊断和治疗上的不一致。此外，近期研究为EGJ腺癌的最佳淋巴结清扫范围提供了更清晰的定义，而本文介绍的针对EGJ腺癌的标准化治疗方法刚好融合了这些新见解，为临床决策提供了一个指导框架。

方法

本研究提出的改良分类法不再单纯依赖肿瘤中点位置，而是基于内镜测量的肿瘤近端和远端边界以及EGJ的确切位置。这种方法根据其扩展范围将肿瘤分为六个类别：SⅠ、SⅠ/Ⅱ、SⅡ、SⅡ/Ⅲ、SⅢ和SⅠ/Ⅱ/Ⅲ。其中，远端边界位于+1 cm至-2 cm之间的下段食管肿瘤被归类为Ⅰ/Ⅱ；近端边界位于此范围内的贲门肿瘤被归类为Ⅱ/Ⅲ；而跨越+1 cm以上且远端超过-2 cm的肿瘤则被归类为Ⅰ/Ⅱ/Ⅲ。对于Siewert Ⅰ、Ⅰ/Ⅱ和Ⅱ型肿瘤，手术治疗方案主要取决于食管受累程度，特别是按照Kurokawa等人的定义（2019），由纵隔基底淋巴结受累的可能性决定。此外，当肿瘤累及颈部或喉返神经淋巴结时，会进行三野淋巴结清扫。

结果

结论

本文提出的EGJ腺癌分类改良方案引入了一个全面的框架，该框架根据肿瘤受累程度进行定制。通过克服现有系统的局限性并融入当前的新见解，这一更新后的分类旨在改进患者分类、标准化治疗方案，从而有可能提升临床治疗效果。