Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study

Yiding Feng,Yiding Feng,Qiang Zhao,Qiang Zhao,Hangyu Zhang,Qixun Chen,Qixun Chen,Youhua Jiang,Jinshi Liu,Jinshi Liu

doi:10.1186/s12893-020-00926-1

Abstract

BackgroundThe incidence rate of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased over the past two decades. Surgery remains the only curative treatment. However, there are currently few studies on Chinese AEG patients. The purpose of this study was to retrospectively analyze the survival and prognostic factors of AEG patients in our center.MethodsBetween January 2008 and September 2014, 249 AEG patients who underwent radical resection were enrolled in this retrospective study, including 196 males and 53 females, with a median age of 64 (range 31–82). Prognostic factors were assessed with the log-rank test and Cox univariate and multivariate analyses.ResultsThe 5-year survival rate of all patients was 49%. The median survival time of all enrolled patients was 70.1 months. Pathological type, intraoperative blood transfusion, tumor size, adjuvant chemotherapy, duration of hospital stay, serum CA199, CA125, CA242 and CEA, pTNM stage, lymphovascular or perineural invasion, and the ratio of positive to negative lymph nodes (PNLNR) were significantly associated with overall survival when analyzed in univariate analysis.ConclusionsOur study found that adjuvant chemotherapy, PNLNR, intraoperative blood transfusion, tumor size, perineural invasion, serum CEA, and duration of hospital stay after surgery had significance in multivariate analysis and were independent risk factors for survival.

Highlights

The incidence rate of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased over the past two decades
Unlike the treatment for gastric cancer, which is standard surgical resection plus D2 lymph node resection, surgery for AEG is still controversial in many ways, Feng et al BMC Surg (2020) 20:302 especially for Siewert type immunohistochemically diagnosed AEG; (II) AEG
Studies have found that the lymph node metastasis rate of AEG is 76.3%, much higher than that of distal gastric adenocarcinoma (67.4%) [9]

Summary

Introduction

The incidence rate of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased over the past two decades. Many population-based studies have shown that the Surgical resection is the main curative treatment for AEG. Unlike the treatment for gastric cancer, which is standard surgical resection plus D2 lymph node resection, surgery for AEG is still controversial in many ways, Feng et al BMC Surg (2020) 20:302 especially for Siewert type II AEG. The surgical treatment of AEG includes primary tumor removal, lymph node dissection and reconstruction of the digestive tract. Studies have found that the lymph node metastasis rate of AEG is 76.3%, much higher than that of distal gastric adenocarcinoma (67.4%) [9]. Other controversial issues include the choice between laparoscopic surgery or open surgery and whether patients with AEG who achieve R0 resection should undergo neoadjuvant chemoradiotherapy

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