title: Extranodal metastasis is a powerful prognostic factor in patients with adenocarcinoma of the esophagogastric junction.
abstract: OBJECTIVE
  The purpose of this study is to estimate the effect of extranodal metastasis (EM) on recurrence and survival in patients with adenocarcinoma of the esophagogastric junction (AEG) after curative resection.
  
  
  METHODS
  Clinical data from 284 node-positive AEG patients who underwent curative resection were reviewed. Univariate and multivariate analyses were conducted to elucidate the effect of EM on recurrence-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  EM was detected in 70 (24.6%) of the 284 cases. It had a significant correlation with tumor size, Lauren type, histopathological grading, depth of tumor invasion, number of metastatic nodes, lymph node ratio, and TNM stage. The 5-year RFS and OS rates were 22.2% and 24.3%, respectively. Patients with EM had a significantly decreased RFS (16 vs. 36 months, P < 0.001) and OS (23 vs. 41 months, P < 0.001) compared with those without EM. Multivariate analyses identified EM as an independent prognostic factor (P = 0.003 and 0.001, respectively).
  
  
  CONCLUSIONS
  The presence of EM increases recurrence probability and reduces OS probability of AEG patients with lymph node metastasis. EM is a powerful prognostic factor reflecting a particularly aggressive biological behavior. Better understanding of EM status can help clinicians with regard to treatment decision and prognosis evaluation.
authors.affiliation: Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China.
authors.forename: Hong-Dian
authors.initials: HD
authors.lastname: Zhang
authors.forename: Peng
authors.initials: P
authors.lastname: Tang
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Duan
authors.forename: Chuan-Gui
authors.initials: CG
authors.lastname: Chen
authors.forename: Zhao
authors.initials: Z
authors.lastname: Ma
authors.forename: Yong-Yin
authors.initials: YY
authors.lastname: Gao
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.forename: Zhen-Tao
authors.initials: ZT
authors.lastname: Yu
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*
keywords: adenocarcinoma of the esophagogastric junction; extranodal metastasis; lymph node metastasis; prognosis; recurrence