Abstract
AimThis study investigated whether esophageal invasion length (EIL) of a tumor from the esophagogastric junction could be a possible indicator of mediastinal lymph node metastasis and survival in patients with Siewert type II adenocarcinoma.MethodsOne hundred and sixty‐eight patients with Siewert type II tumor who underwent surgery were enrolled. Metastatic stations and recurrent lymph node sites were classified into cervical, upper/middle/lower mediastinal, and abdominal zones. EIL was correlated with overall metastasis or recurrence in individual zones and with survival.ResultsSiewert type II patients with an EIL of more than 25 mm (>25 mm EIL group) had a higher incidence of overall metastasis or recurrence in the upper and middle mediastinal zones than those with an EIL of less than or equal to 25 mm (≤25 mm EIL group) (P = .001 and P < .001). Disease‐free and overall survival in the >25 mm EIL group were significantly lower than those of the ≤25 mm EIL group (P < .001). None of the Siewert type II patients with metastasis or recurrence in the upper and middle mediastinal zones survived for more than 5 years. Only an EIL of more than 25 mm was a significant preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zones (odds ratio, 8.85; 95% CI, 2.31‐33.3; P = .001).ConclusionA multimodal‐therapeutic strategy should be investigated in Siewert type II patients once the tumor has invaded more than 25 mm to the esophageal wall.
Highlights
The worldwide incidence of adenocarcinoma of the esophagogastric junction (EGJ) has been increasing in the past few decades.[1,2,3] The Siewert classification divides this entity into three subtypes according to its anatomical localization relative to the EGJ.[4]
Because neoadjuvant chemotherapy or chemoradiotherapy has been introduced as a standard therapy for resectable EGJ adenocarcinoma,[15,16] a new clinical indicator that predicts mediastinal lymph node metastasis prior to treatment needs to be investigated for the prompt selection of surgical strategies, including the extent of lymph node dissection
Histology, esophageal invasion length (EIL), tumor length, epicenter of the tumor, and cN were included in the model as preoperative parameters, but only an EIL of more than 25 mm was found to be an independent significant predictor of overall metastasis or recurrence in the upper and middle mediastinal zones in Siewert type II tumor
Summary
The worldwide incidence of adenocarcinoma of the esophagogastric junction (EGJ) has been increasing in the past few decades.[1,2,3] The Siewert classification divides this entity into three subtypes according to its anatomical localization relative to the EGJ.[4]. Several pathological parameters have been shown to be risk factors for lymph node metastasis in patients with Siewert type II tumors.[11,12,13,14] because neoadjuvant chemotherapy or chemoradiotherapy has been introduced as a standard therapy for resectable EGJ adenocarcinoma,[15,16] a new clinical indicator that predicts mediastinal lymph node metastasis prior to treatment needs to be investigated for the prompt selection of surgical strategies, including the extent of lymph node dissection. We assessed the clinicopathological factors and survival according to EIL to investigate the biological significance of EIL in Siewert type II tumors
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