Proposal for a new definition of true cardia carcinoma.
OBJECTIVE
It remains controversial whether cardia carcinoma should be categorized and treated as esophageal cancer or gastric cancer. The purpose of this study was to develop a reasonable definition of cardia carcinoma.


METHODS
Patients with Siewert type II carcinomas were divided into two subgroups: 25 patients with a tumor center within 1 cm of the esophagogastric junction (EGJ) (type IIA) and 22 patients with tumor center 1-2 cm aboral of the EGJ (type IIB). Patients with subcardia carcinomas, 40 with invasion to the EGJ (type III) and 110 without (type IIIe-), were used as controls.


RESULTS
The patients with type IIB carcinomas showed no different characteristics from those with type III or type IIIe- carcinomas, except for the stage of the disease. On the other hand, those with type IIA carcinomas were associated with a higher male/female ratio, higher incidences of elevated appearance, differentiated histology, and mediastinal node metastasis, and a significantly lower survival rate as compared with patients with subcardia carcinomas. Multivariate survival analysis revealed that type IIA is a significant prognostic determinant, but that type IIB is not.


CONCLUSIONS
Type IIA carcinomas should be treated as true cardia carcinoma; type IIB as subcardia carcinoma. Our results should be confirmed by a prospective study.
Ichikura
Takashi
T
Department of Surgery, National Defense Medical College Hospital, Namiki, Tokorozawa, Japan. ichiku24@ndmc.ac.jp
Chochi
Kentaro
K
Sugasawa
Hidekazu
H
Mochizuki
Hidetaka
H
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D002299:Cardia; D004938:Esophageal Neoplasms / Q000473:pathology; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate