Analysis of survival and prognosis of Siewert Ⅱ/Ⅲ esophagogastric junction adenocarcinoma patients with non-operative acute upper gastrointestinal hemorrhage

Abstract

Objective: To analyze the clinical characteristics and risk factors of non-operative acute upper gastrointestinal hemorrhage in patients with adenocarcinoma of the esophagogastric junction. Methods: The clinical diagnosis and treatment data of patients with adenocarcinoma of esophagogastric junction with non-operative acute upper gastrointestinal hemorrhage admitted to Cancer Hospital of Chinese Academy of Medical Sciences from 2004 to 2018 were collected retrospectively, and the survival of patients was followed up by telephone. SPSS software was used for database establishment and analysis. Cox proportional-hazards model was applied to analyse the survival and related risk factors. Results: A total of 70 patients were included in this study, with a median age of 65 (20-81 years). The ratio of male to female is 2.18∶1. There were 36 cases of Siewert type Ⅱ (51.4%) and 34 cases of Siewert type Ⅲ (48.6%). The lymph node metastasis rates of Siewert Ⅱ and Siewert Ⅲ were 75.0% and 94.1%, respectively (P=0.028). The median overall survival time (OS) of all 70 patients was 11.6 months. The median OS of Siewert Ⅱ and Siewert Ⅲ were 20.0 months and 8.5 months, respectively, and the 1-year survival rates were 42% and 9%, respectively (P=0.027). The median OS of M0 and M1 patients were 19.1 and 7.7 months, respectively, and the 1-year survival rates were 40% and 4%, respectively (P=0.049). The median OS of the treatment of operation+chemotherapy, chemotherapy or best supportive care after hemorrhage were 60.0, 22.2, and 7.9 months, respectively, and the 1-year survival rates were 89%, 45%, and 2%, respectively (all P<0.05). Multivariate analysis showed that Siewert Ⅲ (HR=1.965, 95%CI: 1.078-3.583), M1 stage (HR=1.787, 95%CI: 1.002-3.187) and operation+chemotherapy treatment after hemorrhage (HR=0.132, 95%CI:0.032-0.552) were independent prognostic factors for patients of esophagogastric junction adenocarcinoma with non-operative acute upper gastrointestinal hemorrhage. Conclusions: The survival of patients of esophageal gastric junction adenocarcinoma with non-operative acute upper gastrointestinal hemorrhage is poor, especially for patients of Siewert Ⅲ and the late stage. Active operation and chemotherapy after bleeding may positively affect the survival of these patients.