title: Adenocarcinomas at different positions at the gastro-oesophageal junction show distinct association with gastritis and gastric preneoplastic conditions.
abstract: OBJECTIVE
  Adenocarcinomas at the gastro-oesophageal junction (GOJ) are currently stratified by tumour location. This retrospective study examines the association of preneoplastic conditions and inflammation of the gastric mucosa with GOJ cancer at different locations and compares them with nonjunctional gastric cancers.
  
  
  METHODS
  A total of 520 patients with junctional and nonjunctional gastric cancer were assessed for the presence and degree of intestinal metaplasia, glandular atrophy and inflammation in the stomach. Histopathological data were complete for 428 patients (68.9% men, median age 67.7 years), including 172 patients with GOJ cancer (GOJ1: 1-5 cm proximal to the junction, GOJ2: 'true' junctional, GOJ3: 2-5 cm distal to the junction). Gastric inflammation and preneoplastic conditions were scored according to the updated Sydney classification and further stratified into respective operative link on gastritis assessment (OLGA) and operative link on gastritis assessment on intestinal metaplasia (OLGIM) stages.
  
  
  RESULTS
  The prevalence and degree of gastric atrophy and intestinal metaplasia were significantly lower in GOJ1 than GOJ3 (P<0.01). Preneoplastic conditions in the stomach were similar in GOJ3 compared with nonjunctional gastric cancer. GOJ1 were almost exclusively (98.4%) of the intestinal type, whereas GOJ2 and GOJ3 were the diffuse type in 22.6 and 22.4% of the patients (P<0.001). Of all patients, only 8.5 and 12.7% presented with stage III/IV according to OLGA and OLGIM, respectively. However, data for OLGA and OLGIM staging were only available in 61.2 and 67.9% of patients, respectively.
  
  
  CONCLUSIONS
  GOJ1 are less likely to be associated with gastric pathology compared with GOJ3 or nonjunctional gastric cancer. OLGA or OLGIM staging in patients with advanced gastro-oesophageal cancer seems to be of limited value.
authors.affiliation: aDepartment of Gastroenterology, Hepatology and Infectious Diseases bDepartment of General, Visceral and Vascular Surgery cInstitute of Pathology, Otto-von-Guericke University, Magdeburg, Germany dCancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Bornschein
authors.forename: Andrea
authors.initials: A
authors.lastname: Dingwerth
authors.forename: Michael
authors.initials: M
authors.lastname: Selgrad
authors.forename: Marino
authors.initials: M
authors.lastname: Venerito
authors.forename: Patrick
authors.initials: P
authors.lastname: Stuebs
authors.forename: Katrin
authors.initials: K
authors.lastname: Frauenschlaeger
authors.forename: Achilleas
authors.initials: A
authors.lastname: Achilleos
authors.forename: Albert
authors.initials: A
authors.lastname: Roessner
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001284:Atrophy / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005757:Gastritis, Atrophic / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000473:pathology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*