Prognostic factors for adenocarcinoma of esophagogastric junction

Abstract

INTRODUCTION: The incidence of Barrett’s esophagus is low in Chinese population. Most of our patients who have adenocarcinomas of the esophagogastric junction (AEG) are Siewert type II or III. This study aims to evaluate the outcome after surgical resection in this group of patients, comparing clinicopathological differences between type II and III cancers, and identify prognostic factors. Material and METHODS: Patients who underwent resection for AEG tumors between 1995 and 2008 were included. Those with Siewert type I cancers were excluded. Data were retrieved from a prospectively collected database. Patient characteristics and clinicopathological data and outcome were evaluated. RESULTS: There were 126 patients (99 men, 27 women). The median age was 70 yrs (range: 23-87). Type II tumors were found in 65 patients and type III in 61. Thoracotomy was required for tumor extirpation in 50 (76.9%) and 34 (55.7%) patients, respectively (p=0.014). The operative blood loss was higher for type III tumors (median 300 ml vs. 400ml, p=0.005). There was no hospital mortality. Type III AEG was associated with significantly higher incidence of poorly differentiated cancer (44.6% vs. 73.8%, p=0.003), higher number of nodal metastasis (median 3 vs. 7, p=0.031), and advanced TNM stage (stage IIIA-IV disease in 64.6% vs. 86.9%, p=0.004). Overall median survival for the whole group was 17 months. Patients with type II AEG had longer survival (37.6 vs. 10.4 months), (p<0.01). Independent variables identified by Cox regression model for better survival were Siewert type II (p=0.021), earlier N-stage (p<0.01) and R0 resection (p<0.01).CONCLUSION: Type III AEG tumors were more likely to be poorly differentiated, more advanced and had worse survival compared to type II AEG cancers. Other independent prognostic factors were N-stage and R-category of resection.