title: Proposal for a new definition of true cardia carcinoma.
abstract: 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.
authors.affiliation: Department of Surgery, National Defense Medical College Hospital, Namiki, Tokorozawa, Japan. ichiku24@ndmc.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichikura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Chochi
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Sugasawa
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Mochizuki
mesh_terms: 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