Clinical-pathological features and prognosis analysis of 218 esophagogastric junction malignant tumor

Abstract

Objective To explore the relation between clinical-pathological features, Siewert classification and prognosis of esophagogastric junction (EGJ) carcinoma, and to assess the applicability of the new edition of American Joint Committee of Cancer (AJCC) staging guideline on EGJ adenocarcinoma in China. Methods From 2002 to 2012, the clinical data, pathological features, treatment and prognosis of 218 patients with EGJ malignant tumor were retrospectively analyzed. The patients were typed according to Siewert classification criteria and each case was staged according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma and gastric cancer. Kaplan-Meier method and Log-rank test were performed for survival analysis. Results According to the Siewert classification, type Ⅰ was rare (nine cases, 4.1%), type Ⅱ was the most common type (150 cases, 68.8%) and followed by type Ⅲ (59 cases, 27.1%). There was no significant difference in survival curve among the three types (P>0.05). The survival curve was drawn according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma. In T staging, the prognosis of patients at T4b was better than that of patients at T4a, the prognosis of patients at ⅡB was better than that of patients at ⅡA. The survival curve of patients at ⅢC obviously crossed with that of patients at Ⅳ, which was not in conformity with clinical results. The survival curve was drawn according to 7th edition of AJCC staging criteria for gastric cancer. In T staging, the survival curve of patients at Tis was overlapped with that of patients at T1a. The survival rate of patients at ⅡB could not be accurately predicted by the overall staging. In general, the survival of patients with EGJ carcinoma was better predicted according to 7th edition of AJCC staging criteria for gastric cancer than 7th edition for esophagus adenocarcinoma. Conclusions Neither 7th edition of AJCC staging criteria for esophagus adenocarcinoma nor for gastric cancer could accurately predict its prognosis. In our country, EGJ malignant tumor was similar to gastric cancer and had specific clinical-pathological features. It is necessary to research and establish EGJ carcinoma staging criteria instead of applying the current staging criteria for esophagus adenocarcinoma or gastric cancer. Key words: Gastroesophageal junction cancer; Clinical-pathological features; Prognosis; 7th edition of AJCC staging criteria