title: Clinicopathological characteristics and optimal management for esophagogastric junctional cancer; a single center retrospective cohort study.
abstract: BACKGROUND
  Esophagogastric junctional (EGJ) cancer occurs in the mucosa near the esophagogastric junction, and has characteristics of both esophageal and gastric malignancies; its optimal treatment strategy is controversial.
  
  
  METHODS
  We conducted a single-center retrospective cohort study of the patients who underwent curative surgery with lymphadenectomy for EGJ cancer. Tumor specimens were categorized by histology and location into four types-centered in the esophagus < 5 cm from EGJ (type E), which were subtyped as (i) squamous-cell carcinoma (SQ) or (ii) adenocarcinoma (AD); (iii) any histological tumor centered in the stomach < 5 cm from EGJ, with EGJ invasion (type Ge); (iv) any histological tumor centered in the stomach < 5 cm from EGJ, without EGJ invasion (type G)-and classified by TNM system; these were compared to patients' clinicopathological characteristics and survival outcomes.
  
  
  RESULTS
  A total of 92 EGJ cancer patients were studied. Median follow-up of surviving patients was 35.5 months. Tumors were categorized as 12 type E (SQ), 6 type E (AD), 27 type Ge and 47 type G; of these 7 (58.3%), 3 (50%), 19 (70.4%) and 14 (29.8%) and 23 patients, respectively, had lymph node metastases. No patients with type E (AD) and Ge tumors had cervical lymph node metastasis; those with type G tumors had no nodal metastasis at cervical and mediastinal lymph nodes. Multivariate analysis showed that type E (AD) tumor was an independent prognostic factor.
  
  
  CONCLUSIONS
  We should distinguish type Ge tumor from type E (AD) tumor because of the clinicopathological and prognostic differentiation. Extended gastrectomy with or without lower esophagectomy according to tumor location and lower mediastinal and abdominal lymphadenectomy are recommended for EGJ cancer.
  
  
  BACKGROUND
  University Hospital Medical Information Network in Japan, UMIN000008596.
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasakichuo Tsuzuki-ku, Yokohama 224-8503, Japan. h.ito@med.showa-u.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ito
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.forename: Noriko
authors.initials: N
authors.lastname: Odaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Satodate
authors.forename: Michitaka
authors.initials: M
authors.lastname: Suzuki
authors.forename: Shumpei
authors.initials: S
authors.lastname: Mukai
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takehara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kida
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Kudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis