title: Lower mediastinal lymph node metastasis is an independent survival factor of Siewert type II and III adenocarcinomas in the gastroesophageal junction.
abstract: We examined clinicopathological features and surgical outcomes in patients with adenocarcinoma in the gastroesophageal junction (GEJ), while also analyzing the survival factors that have a prognostic impact. Between 1991 and 2009, 61 patients with tumors in the GEJ (Siewert type II  and III) underwent primary surgical resection. Thirty of 61 patients had type II tumors (49.2%) and 31 had type III tumors (50.8%). The tumor size was larger in type III tumors than type II tumors (P = 0.0026). The overall 5-year survival rates in patients with type II tumors and type  III tumors were 44.2 per cent and 41.4 per cent, respectively, with no significant differences (P = 0.1888). The independent survival factors were lower mediastinal lymph node metastasis (P = 0.0323) and a noncurative resection (P = 0.0442). The independent survival factors  for patients who underwent curative resections were the tumor size (P = 0.0422), M category (P = 0.0489), and lower mediastinal lymph node metastasis (P = 0.0482). This study showed lower mediastinal lymph node metastasis to be an independent survival factor, and also  suggested that lower mediastinal lymph node metastasis was associated with distant metastasis in patients with adenocarcinoma in the GEJ (Siewert type II and III). Therefore, the preoperative early detection of such metastasis is important to improve patient survival.
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Nakamura
authors.forename: Makoto
authors.initials: M
authors.lastname: Iwahashi
authors.forename: Mikihito
authors.initials: M
authors.lastname: Nakamori
authors.forename: Teiji
authors.initials: T
authors.lastname: Naka
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Ojima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Katsuda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tsuji
authors.forename: Keiji
authors.initials: K
authors.lastname: Hayata
authors.forename: Shuuichi
authors.initials: S
authors.lastname: Mastumura
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary*; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D004943:Esophagogastric Junction; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed