Clinicopathological characteristics and optimal management for esophagogastric junctional cancer; a single center retrospective cohort study.

Abstract

BACKGROUND:

Esophagogastric junctional (EGJ) cancer occurs in the mucosa near the esophagogastric junction, and has characteristics of both esophageal and gastric malignancies; its optimal treatment strategy is controversial.

METHODS:

We conducted a single-center retrospective cohort study of the patients who underwent curative surgery with lymphadenectomy for EGJ cancer. Tumor specimens were categorized by histology and location into four types-centered in the esophagus < 5 cm from EGJ (type E), which were subtyped as (i) squamous-cell carcinoma (SQ) or (ii) adenocarcinoma (AD); (iii) any histological tumor centered in the stomach < 5 cm from EGJ, with EGJ invasion (type Ge); (iv) any histological tumor centered in the stomach < 5 cm from EGJ, without EGJ invasion (type G)-and classified by TNM system; these were compared to patients' clinicopathological characteristics and survival outcomes.

RESULTS:

A total of 92 EGJ cancer patients were studied. Median follow-up of surviving patients was 35.5 months. Tumors were categorized as 12 type E (SQ), 6 type E (AD), 27 type Ge and 47 type G; of these 7 (58.3%), 3 (50%), 19 (70.4%) and 14 (29.8%) and 23 patients, respectively, had lymph node metastases. No patients with type E (AD) and Ge tumors had cervical lymph node metastasis; those with type G tumors had no nodal metastasis at cervical and mediastinal lymph nodes. Multivariate analysis showed that type E (AD) tumor was an independent prognostic factor.

CONCLUSIONS:

We should distinguish type Ge tumor from type E (AD) tumor because of the clinicopathological and prognostic differentiation. Extended gastrectomy with or without lower esophagectomy according to tumor location and lower mediastinal and abdominal lymphadenectomy are recommended for EGJ cancer.

TRIAL REGISTRATION:

University Hospital Medical Information Network in Japan, UMIN000008596.

• Authors: Hiroaki Ito, Haruhiro Inoue, Noriko Odaka, Hitoshi Satodate, Michitaka Suzuki, Shumpei Mukai, Yusuke Takehara, Hiroyuki Kida, Shin-Ei Kudo
• Journal: Journal of experimental & clinical cancer research : CR (J Exp Clin Cancer Res) Vol. 32 Pg. 2 (Jan 07 2013) ISSN: 1756-9966 [Electronic] England
• PMID: 23289488 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cohort Studies
• Esophageal Neoplasms (pathology, surgery)
• Esophagogastric Junction (pathology, surgery)
• Female
• Humans
• Lymph Node Excision
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Survival Analysis