Differential pathologic variables and outcomes across the spectrum of adenocarcinoma of the esophagogastric junction.
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.
Reynolds
John V
JV
Department of Surgery, St. James's Hospital and Trinity College Dublin, Trinity Center, Dublin 8, Ireland. reynoljv@tcd.ie
Ravi
Narayanasamy
N
Muldoon
Cian
C
Larkin
John O
JO
Rowley
Suzanne
S
O'Byrne
Ken
K
Hollywood
Donal
D
O'Toole
Dermot
D
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
Ann Surg. 2009 Nov;250(5):729-37
19801928
Br J Surg. 2005 Jan;92(1):60-7
15584066
Ann Surg. 2008 Feb;247(2):365-71
18216546
Cancer. 1998 Nov 15;83(10):2049-53
9827707
Br J Surg. 1998 Nov;85(11):1457-9
9823902
N Engl J Med. 2006 Jul 6;355(1):11-20
16822992
Ann Surg. 2008 Oct;248(4):549-56
18936567
Cancer. 1994 Jun 1;73(11):2680-6
8194005
Aliment Pharmacol Ther. 2004 Oct;20 Suppl 5:55-60; discussion 61-2
15456465
Oncology. 2010;78(1):26-33
20185938
Ann Oncol. 2009 May;20(5):885-91
19164454
Hum Pathol. 2006 Jan;37(1):40-7
16360414
J Am Coll Surg. 2007 Oct;205(4 Suppl):S49-53
17916519
Ann Surg. 2007 Jul;246(1):1-8
17592282
J Thorac Cardiovasc Surg. 2009 Sep;138(3):594-602; discussion 601-2
19698841
N Engl J Med. 1999 Mar 18;340(11):825-31
10080844
Ann Thorac Surg. 2007 May;83(5):1814-9
17462405
Ann Surg. 2000 Sep;232(3):353-61
10973385
World J Surg Oncol. 2006 Nov 21;4:82
17118194
Ann Surg. 2007 May;245(5):707-16
17457163
Am J Surg Pathol. 2007 Apr;31(4):569-75
17414104