Influencing factors of lymph node metastasis and its effect on prognosis for patients withSiewert <b>Ⅱ</b>/<b>Ⅲ</b> gastroesophageal junctional adenocarcinoma _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GAO Jun , LI Fuliang , HE Xu

Department of General Surgery, Shiyan Hospital of Traditional Chinese, Shiyan, Hubei 442012, P. R. China;

Corresponding author：

GAO Jun, Email: bluexiao2018@163.com

Keywords：

adenocarcinoma of gastroesophageal junction; lymph node metastasis; prognosis

DOI：

10.7507/1007-9424.201806013

Video：

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Objective To explore the influencing factors of lymph node metastasis of Siewert Ⅱ/Ⅲ gastroesophageal junction adenocarcinoma (AEG) and its influence on prognosis of this kind of patients. Methods The clinical and pathological data of 49 patients with Siewert Ⅱ/Ⅲ AEG who admitted to Shiyan Hospital of Traditional Chinese from January 2010 to January 2013 were retrospectively analyzed. Univariate and multivariate analyses of factors affecting lymph node metastasis of AEG were performed by using a chi-square test and an unconditional logistic regression model; the effect of lymph node metastasis on the prognosis of patients with Siewert Ⅱ/Ⅲ AEG was performed by log-rank test. Results Multivariate unconditional logistic regression analysis showed that, tumor diameter (P=0.008), depth of invasion (P=0.019), vascular tumor thrombus (P=0.020), and degree of differentiation (P=0.017) were all influencing factors of lymph node metastasis. Patients with Siewert Ⅱ/Ⅲ AGE without lymph node metastasis had better survival than those with lymph node metastasis (P=0.005). Conclusion Tumor diameter, depth of invasion, degree of differentiation, and vascular tumor thrombus are independent risk factors for lymph node metastasis in patients with Siewert Ⅱ/Ⅲ AEG, and lymph node metastasis is associated with poor prognosis.

Citation： GAO Jun, LI Fuliang, HE Xu. Influencing factors of lymph node metastasis and its effect on prognosis for patients withSiewert Ⅱ/Ⅲ gastroesophageal junctional adenocarcinoma . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1327-1331. doi: 10.7507/1007-9424.201806013 Copy

1.	张理想, 韩文秀, 韦之见, 等. Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌预后因素及淋巴结转移率影响因素分析. 中华消化外科杂志, 2017, 16(5): 490-495.
2.	Deans C, Yeo MS, Soe MY, et al. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg, 2011, 35(3): 617-624.
3.	Steevens J, Botterweck AA, Dirx MJ, et al. Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol, 2010, 22(6): 669-678.
4.	Zhang H, Shang X, Chen C, et al. Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection. Oncotarget, 2016, 7(45): 74337-74349.
5.	Turkington RC, Parkes E, Kennedy RD, et al. Clinical tumor staging of adenocarcinoma of the esophagus and esophagogastric junction. J Clin Oncol, 2015, 33(9): 1088.
6.	Zheng Z, Cai J, Yin J, et al. Transthoracic versus abdominal-transhiatal resection for treating Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction: a meta-analysis. Int J Clin Exp Med, 2015, 8(10): 17167-17182.
7.	Hasegawa S, Yoshikawa T, Rino Y, et al. Priority of lymph node dissection for Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Ann Surg Oncol, 2013, 20(13): 4252-4259.
8.	Matsuda T, Takeuchi H, Tsuwano S, et al. Optimal surgical management for esophagogastric junction carcinoma. Gen Thorac Cardiovasc Surg, 2014, 62(9): 560-566.
9.	Hasegawa S, Yoshikawa T, Cho H, et al. Is adenocarcinoma of the esophagogastric junction different between Japan and western countries? The incidence and clinicopathological features at a Japanese high-volume cancer center. World J Surg, 2009, 33(1): 95-103.
10.	Mullen JT, Kwak EL, Hong TS. What’s the best way to treat GE junction tumors? Approach like gastric cancer. Ann Surg Oncol, 2016, 23(12): 3780-3785.
11.	Matsuda T, Kurokawa Y, Yoshikawa T, et al. Clinicopathological characteristics and prognostic factors of patients with Siewert type Ⅱ esophagogastric junction carcinoma: a retrospective multicenter study. World J Surg, 2016, 40(7): 1672-1679.
12.	Ito H, Inoue H, Odaka N, et al. Clinicopathological characteristics and optimal management for esophagogastric junctional cancer; a single center retrospective cohort study. J Exp Clin Cancer Res, 2013, 32: 2.
13.	Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
14.	Washington K. 7^th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol, 2010, 17(12): 3077-3079.
15.	Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg, 2007, 24(2): 96-100.
16.	Duan XF, Yue J, Tang P, et al. Lymph node dissection for Siewert Ⅱ esophagogastric junction adenocarcinoma: a retrospective study of 3 surgical procedures. Medicine (Baltimore), 2017, 96(7): e6120.
17.	Yasuda K, Shiraishi N, Suematsu T, et al. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer, 1999, 85(10): 2119-2123.
18.	Zheng Z, Yin J, Wu HW, et al. Explored risk factors for lymph node metastasis with Siewert Ⅱ/Ⅲ adenocarcinoma of the gastroesophageal junction. Anticancer Res, 2017, 37(8): 4605-4610.
19.	Kofoed SC, Muhic A, Baeksgaard L, et al. Survival after adjuvant chemoradiotherapy or surgery alone in resectable adenocarcinoma at the gastro-esophageal junction. Scand J Surg, 2012, 101(1): 26-31.
20.	Wu XN, Liu CQ, Tian JY, et al. Prognostic significance of the number of lymph nodes examined in node-negative Siewert type Ⅱ esophagogastric junction adenocarcinoma. Int J Surg, 2017, 41: 6-11.
21.	Sisic L, Blank S, Weichert W, et al. Prognostic impact of lymph node involvement and the extent of lymphadenectomy (LAD) in adenocarcinoma of the esophagogastric junction (AEG). Langenbecks Arch Surg, 2013, 398(7): 973-981.
22.	Matsuda T, Kurokawa Y, Yoshikawa T, et al. Clinicopathological characteristics and prognostic factors of patients with Siewert type Ⅱ esophagogastric junction carcinoma: a retrospective multicenter study. World J Surg, 2016, 40(7): 1672-1679.
23.	Steup WH, De Leyn P, Deneffe G, et al. Tumors of the esophagogastric junction. Long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification. J Thorac Cardiovasc Surg, 1996, 111(1): 85-94.

1. 张理想, 韩文秀, 韦之见, 等. Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌预后因素及淋巴结转移率影响因素分析. 中华消化外科杂志, 2017, 16(5): 490-495.
2. Deans C, Yeo MS, Soe MY, et al. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg, 2011, 35(3): 617-624.
3. Steevens J, Botterweck AA, Dirx MJ, et al. Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol, 2010, 22(6): 669-678.
4. Zhang H, Shang X, Chen C, et al. Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection. Oncotarget, 2016, 7(45): 74337-74349.
5. Turkington RC, Parkes E, Kennedy RD, et al. Clinical tumor staging of adenocarcinoma of the esophagus and esophagogastric junction. J Clin Oncol, 2015, 33(9): 1088.
6. Zheng Z, Cai J, Yin J, et al. Transthoracic versus abdominal-transhiatal resection for treating Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction: a meta-analysis. Int J Clin Exp Med, 2015, 8(10): 17167-17182.
7. Hasegawa S, Yoshikawa T, Rino Y, et al. Priority of lymph node dissection for Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Ann Surg Oncol, 2013, 20(13): 4252-4259.
8. Matsuda T, Takeuchi H, Tsuwano S, et al. Optimal surgical management for esophagogastric junction carcinoma. Gen Thorac Cardiovasc Surg, 2014, 62(9): 560-566.
9. Hasegawa S, Yoshikawa T, Cho H, et al. Is adenocarcinoma of the esophagogastric junction different between Japan and western countries? The incidence and clinicopathological features at a Japanese high-volume cancer center. World J Surg, 2009, 33(1): 95-103.
10. Mullen JT, Kwak EL, Hong TS. What’s the best way to treat GE junction tumors? Approach like gastric cancer. Ann Surg Oncol, 2016, 23(12): 3780-3785.
11. Matsuda T, Kurokawa Y, Yoshikawa T, et al. Clinicopathological characteristics and prognostic factors of patients with Siewert type Ⅱ esophagogastric junction carcinoma: a retrospective multicenter study. World J Surg, 2016, 40(7): 1672-1679.
12. Ito H, Inoue H, Odaka N, et al. Clinicopathological characteristics and optimal management for esophagogastric junctional cancer; a single center retrospective cohort study. J Exp Clin Cancer Res, 2013, 32: 2.
13. Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
14. Washington K. 7^th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol, 2010, 17(12): 3077-3079.
15. Nomura S, Kaminishi M. Surgical treatment of early gastric cancer. Dig Surg, 2007, 24(2): 96-100.
16. Duan XF, Yue J, Tang P, et al. Lymph node dissection for Siewert Ⅱ esophagogastric junction adenocarcinoma: a retrospective study of 3 surgical procedures. Medicine (Baltimore), 2017, 96(7): e6120.
17. Yasuda K, Shiraishi N, Suematsu T, et al. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer, 1999, 85(10): 2119-2123.
18. Zheng Z, Yin J, Wu HW, et al. Explored risk factors for lymph node metastasis with Siewert Ⅱ/Ⅲ adenocarcinoma of the gastroesophageal junction. Anticancer Res, 2017, 37(8): 4605-4610.
19. Kofoed SC, Muhic A, Baeksgaard L, et al. Survival after adjuvant chemoradiotherapy or surgery alone in resectable adenocarcinoma at the gastro-esophageal junction. Scand J Surg, 2012, 101(1): 26-31.
20. Wu XN, Liu CQ, Tian JY, et al. Prognostic significance of the number of lymph nodes examined in node-negative Siewert type Ⅱ esophagogastric junction adenocarcinoma. Int J Surg, 2017, 41: 6-11.
21. Sisic L, Blank S, Weichert W, et al. Prognostic impact of lymph node involvement and the extent of lymphadenectomy (LAD) in adenocarcinoma of the esophagogastric junction (AEG). Langenbecks Arch Surg, 2013, 398(7): 973-981.
22. Matsuda T, Kurokawa Y, Yoshikawa T, et al. Clinicopathological characteristics and prognostic factors of patients with Siewert type Ⅱ esophagogastric junction carcinoma: a retrospective multicenter study. World J Surg, 2016, 40(7): 1672-1679.
23. Steup WH, De Leyn P, Deneffe G, et al. Tumors of the esophagogastric junction. Long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification. J Thorac Cardiovasc Surg, 1996, 111(1): 85-94.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Influencing factors of lymph node metastasis and its effect on prognosis for patients withSiewert Ⅱ/Ⅲ gastroesophageal junctional adenocarcinoma

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