Oncology Frontier: There is still controversy regarding the anatomical location of EG-junction tumors. Do you have any updates on the EG-junction tumor location?

　　《肿瘤瞭望》：目前对食管-胃交界处肿瘤的解剖定位尚有争议。您的研究中，有没有一个更简单或者更精准的定义呢？

　　Dr Coit: I believe we can develop a staging system which embraces the entire range of presentations in the foregut from the esophagus through to the stomach. It is very clear that the prognosis for proximal tumors is worse than the prognosis for distal tumors， so I am not sure that a staging system should dictate treatment. I think that treatment should be risk-driven， not staging-driven. But there is a staging system that encompasses a general language to describe the entire foregut. If we can embrace that staging system， then we can end this debate about whether the GE-junction is one centimeter above or below the Z-line， because otherwise， we will never agree on that. The first goal is to recognize the harmony and staging of the foregut tumors. The second goal is to recognize the differences within foregut tumors and to tailor treatment appropriately.

　　Dr Coit：我相信我们能够创建一个分期系统来对从食管到胃的上消化道的疾病进行分期。我们都知道近端肿瘤的预后差于远端肿瘤，所以我不是很确信这个分期系统可以很好地决定治疗方案。我觉得治疗方案的选择应该由风险决定，而不应该由分期所决定。但是有个分期系统可以普遍适用于整个上消化道。如果我们能够接受这样的分期系统，我们就可以结束关于食管-胃交界处是在Z线上面还是下面1cm的争论，因为不是这样的话我们将永远没办法达到共识。第一个目标是明确整个上消化道的共识和分期，第二个目标是了解各种上消化道肿瘤之间的差异和针对每种肿瘤合适的治疗方法。

　　Oncology Frontier: It used to be recommended that EG-junction tumors should follow TMN staging of gastric cancers if it is adenocarcinoma， and esophagus staging if it is squamous cell carcinoma. Do you have a preference， or an opinion as to why it is no longer recommended?

　　《肿瘤瞭望》：既往有人认为食管-胃交界处肿瘤的TMN分期，假如是腺癌则应该遵循胃癌TMN分期，假如是鳞癌则遵循食管癌TMN分期。那么您对这个观点有什么看法呢？

　　Dr Coit: My strong feeling is that adenocarcinoma of the GE-junction should be part of a uniform foregut staging system that embraces the GE-junction and the stomach. That staging system should be quite different from that of squamous cancer. They are very different cancers with different biologies. That doesn’t mean that we should treat all foregut tumors the same. It is increasingly clear that the treatment paradigms for the more proximal focal tumors in the GE-junction are different， largely for anatomic reasons compared to the more anatomically diffuse gastric cancers.

　　Dr Coit：我强烈地认为食管-胃交界处腺癌应该采用整个上消化道的统一的分期系统。这个分期系统应该和鳞癌的分期系统不一样。他们是具有不同特性的不同肿瘤。这就意味着我们不应该对等地对待上消化道的所有肿瘤。由于解剖学原因，和弥漫型胃癌相比，食管-胃交界处的近端肿瘤的治疗与之明显不同。

　　Oncology Frontier: How does the epidemiology of EG-junction tumors in the US differ with that in Asian countries?

　　《肿瘤瞭望》：美国的食管-胃交界处肿瘤，其流行病学特征与亚洲国家相比有什么不同？

　　Dr Coit: I am not sure that we know that the epidemiology of GE-junction tumors in a given location is different in Asia to what it is in the West. I do think we are seeing an increased incidence of GE-junction cancers in Asia and that may be because of the fact that those risk factors that we have in the West are now becoming more prominent in Japan and Korea， for example. I am not sure that the epidemiology is different; I think it may be that the environment is changing and leading to differences in incidence.

　　Dr Coit：我不确信东西方在特定部位的食管-胃交界处肿瘤的流行病学存在明显差异。但是我认为亚洲国家的食管-胃交界处肿瘤的发病率在增高，可能是因为在西方存在的那些危险因素在日本和韩国这样的亚洲城市中成为显著的因素。我不确定东西方食管-胃交界处肿瘤的流行病学特征是不同的，但是我觉得环境的改变导致了发生率的差异。

　　Oncology Frontier: What about the epidemiology of EG-junction tumors in the US? Do you have any new evidence to support your research?

　　《肿瘤瞭望》：美国食管-胃交界处肿瘤的流行病学如何？有什么最新的数据支持呢？

　　Dr Coit: We are learning more about the epidemiology of GE-junction tumors in the US. Most of the epidemiologic studies now have been supplanted by molecular biology and genetics. I think what we are going to find is that there is enormous heterogeneity within gastric cancers and GE-junction tumors whose origins can be traced to the genetic drivers of the tumor. For the most part， when we talk about epidemiology， we are talking about the view from 30000 feet， but what we really want to do is get down and look at the individual drivers in individual tumors. We have seen this with the HER2 story， where HER2 amplification is much more common in GE-junction cancer than in gastric cancer. We are going to start to have a much better understanding of the genetic drivers of cancers in all locations. So I think the issue of the epidemiology of those tumors is interesting because it does highlight some of the differences， but it is going to be supplanted by a much better understanding of the genetic heterogeneity of these tumors.

　　Dr Coit：我们现在正在研究美国食管-胃交界处肿瘤的流行病学特征。大部分流行病学研究已经被分子生物学和遗传学研究所排挤。我觉得我们想发现的就是源于肿瘤的基因驱使导致的胃癌和食管-胃交界处肿瘤之间的异质性。总的来说，当我们讨论流行病学特征的时候，我们就像站在30000英尺的高空俯视这个问题。但是我们真正想做的就是走下来和找到每个肿瘤患者的个体驱使因素。我们发现HER2与之明显相关，相比胃癌而言食管-胃交界处肿瘤的HER2扩增更常见。我们想开始研究如何更好地理解在全部解剖位置上肿瘤的基因驱使因子。我觉得这些肿瘤的流行病学特征是有趣的，因为它强调了一些明显的差异。但是和这些肿瘤的基因异质性相比，流行病学资料相对就没有那么重要了。

　　Oncology Frontier: Do you have any suggestions for the treatment of EG-junction tumors? For example， would you recommend the multidisciplinary approach (MDT) for the treatment of EG-junction tumors?

　　《肿瘤瞭望》：食管-胃交界处肿瘤的治疗上，您在方面有什么经验分享？请谈一下您对目前提倡的多学科交叉治疗的看法？

　　Dr Coit: There are a number of cultural differences and almost geographic differences in the way that people assess the Level I evidence in treating GE-junction tumors. The data are the data. Do I believe that a multidisciplinary review and management of these patients is essential? Yes， I do. It would be ideal if every patient underwent review to take advantage of Level I evidence， new techniques and things like that， but from a practical standpoint， I don’t see that happening in places other than major cancer centers. The Dutch has started the concept of regionalization of uncommon diseases that are technically demanding and potentially morbid and I think that is a model for the world. But not every society is prepared to do that. However， to be able to centralize care and have patients treated in a multidisciplinary setting， is far and away the ideal approach， mainly because it would help us answer some of the differences in opinion about management of a single disease.

　　Dr Coit：人们评估治疗食管-胃交界处肿瘤疗效存在着文化和地域上的差异。但是数据只是数据。大家不知道对于这些患者的多学科回顾和管理是不是必须，但我认为这是必须的。如果对于每一个患者我们都采用一级证据、新的技术和多学科管理，我觉得他们的预后肯定会相对理想。但是从一个实际的出发点看，我认为这样的结果可能只能出现在大的癌症中心。荷兰已经开始明确那些技术要求较高和潜在风险较大的特殊疾病的区域化概念。但是，对于患者集中的关注和综合治疗还很难实现这样理想化的方案，主要是因为它帮我们回答了对于单个疾病的管理方面的差异性观念。