Patients with esophageal adenocarcinoma had significantly better outcomes than patients with adenocarcinoma of the gastroesophageal junction.

Abstract

Recent genomic studies by the Cancer Genome Atlas show much simpler genomic profiles in distal esophageal adenocarcinoma (EAC) than in adenocarcinoma of the gastroesophageal junction (AGEJ). However, the prognostic significance of categorizing patients in these two cancer groups remains unknown. We studied clinicopathologic and prognostic features of both cancers in 303 consecutive patients treated at the Veterans Affairs Boston Healthcare System over a 20-year period. Using uniform criteria and standardized routines, we studied and statistically compared the clinicopathologic and prognostic features between EAC and AGEJ. In this cohort, over 99% of patients were white men with mean age of 69.1 years and an average body mass index of 28.0. No significant difference was detected in age, gender, ethnicity, body mass index, and history of tobacco abuse between the two groups. Compared to AGEJ patients, a significantly higher proportion of EAC patients had gastroesophageal reflux disease, long-segment Barrett's esophagus, common adenocarcinoma type, smaller tumor size, better differentiation, more stages I/II but fewer stages III/IV diseases, scarcer lymphovascular invasion, fewer nodal and distant metastases, and better overall, disease-free, and relapse-free survival. The 5-year overall survival rate was significantly higher in EAC patients (41.3%) than in AGEJ patients (17.2%) (p<0.001). This improved survival among EAC patients remained significant after censoring all cases discovered during surveillance, suggesting different pathogenesis mechanisms between EAC and AGEJ. Our findings suggest that EAC patients showed significantly better outcomes than AGEJ patients. Our results require validation in other patient populations.