title: Differential pathologic variables and outcomes across the spectrum of adenocarcinoma of the esophagogastric junction.
abstract: BACKGROUND
  Adenocarcinoma of the esophagogastric junction (AEG) as described by Siewert et al. is classified as one entity in the latest (7th Edition) American Joint Cancer Committee/International Union Against Cancer (AJCC/UICC) manual, compared with the previous mix of esophageal and gastric staging systems. The origin of AEG tumors, esophageal or gastric, and their biology remain controversial, particularly for AEG type II (cardia) tumors.
  
  
  METHODS
  We adapted a large prospective database (n = 520: 180 type I, 182 type II, 158 type III) to compare AEG tumors under the new TNM system Pathological variables associated with prognosis were compared (pT, pN, stage, differentiation, R status, lymphovascular invasion, perineural involvement, number of positive nodes, percent of positive nodes, and tumor length), as well as overall survival.
  
  
  RESULTS
  Compared with AEG type I tumors, type II and type III tumors had significantly (p < 0.05) more advanced pN stages, greater number and percentage of positive nodes, poorer differentiation, more radial margin involvement, and more perineural invasion. In AEG type I, 14/180 patients (8%) had >6 involved nodes (pN3), compared with 16 and 30% of patients classified type II and III, respectively. Median survival was significantly (p = 0.03) improved for type I patients (38 months) compared with those with tumors classified as type II (28 months) and type III (24 months). In multivariate analysis node positivity and pN staging but not AEG site had an impact on survival.
  
  
  CONCLUSIONS
  In this series AEG type I is associated with more favorable pathologic features and improved outcomes compared with AEG type II and III. This may reflect earlier diagnosis, but an alternative possibility, that type I may be a unique paradigm with more favorable biology, requires further study.
authors.affiliation: Department of Surgery, St. James's Hospital and Trinity College Dublin, Trinity Center, Dublin 8, Ireland. reynoljv@tcd.ie
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
authors.forename: Narayanasamy
authors.initials: N
authors.lastname: Ravi
authors.forename: Cian
authors.initials: C
authors.lastname: Muldoon
authors.forename: John O
authors.initials: JO
authors.lastname: Larkin
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rowley
authors.forename: Ken
authors.initials: K
authors.lastname: O'Byrne
authors.forename: Donal
authors.initials: D
authors.lastname: Hollywood
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
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