Pattern of lymphatic metastasis of Siewert type II and III adenocarcinoma of the esophagogastric junction

Abstract

Objective To investigate the pattern of lymphatic metastasis of Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The clinical data of 152 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Dalian Medical University from January 2003 to December 2007 were retrospectively analyzed.The follow-up began at the first admission,and ended at December 2012 or the death of patients.Patients were followed up via phone call.The unordered data were analyzed using the chi-square test,and the ordered data were analyzed using the analysis of variance.The survival curve drawn using the Kaplan-Meier method,and the comparison of survival rates was done by Log-rank test.Results Of the 152 patients,138 received R0 resection,14 received R1 or R2 resection.The overall R0 resection rate was 90.79％ (138/152).The R0 resection rates of patients with Siewert type Ⅱ,Ⅲ AEG were 92.6％ (63/68) and 89.3％ (75/84).For Siewert type Ⅱ AEG,the incidences of lymphatic metastasis were high in No.1 (63.6％),No.2 (56.4％),No.3 (54.5％),No.7 (47.3％),No.8a (23.6％) and No.110 (23.6％) lymph nodes,and then followed by No.11 (16.4％),No.111 (16.4％) and No.9 (12.7％) lymoh nodes.For Siewert type Ⅲ AEG,the incidences of lymphatic metastasis were high in No.1 (60.6％),No.2 (57.7％),No.3 (50.7％),No.7 (46.5％),No.8a(28.2％),No.4sb(26.8％),No.11 (23.9％),No.4sa (19.7％),No.4d (11.3％) lymph nodes,and then followed by No.9 (19.7％),No.10 (16.9％),No.5 (14.1％) and No.6 (12.7％) lymph nodes.The metastatic rates of No.4sa,4sb,4d,5,6,10 and 11 lymph nodes of Siewert type Ⅱ AEG were significantly lower than those of Siewcrt type Ⅲ AEG,while the metastatic rates of No.110 and 111 lymph nodes of Siewert type Ⅱ AEG were significantly higher than those of Siewert type Ⅲ AEG (x2 =2.132,4.271,8.317,2.801,6.143,7.327,7.491 ; 8.014,5.386,P ＜0.05).A total of 145 patients were followed up,with the follow-up rate of 95.39％ (145/152).One hundred and thirty-seven patients with R0 resection were selected for survival evaluation,including 63 patients with Siewert type Ⅱ AEG and 74 with Siewert type Ⅲ AEG.The 5-year survival rate of Siewert type Ⅱ AEG patients was 52.4％,which was significantly higher than 40.5％ of Siewert type Ⅲ AEG patients (x2 =3.419,P ＜ 0.05).The 5-year survival rates of Siewert type Ⅱ AEG patients with and without lymph node metastasis were 32.4％ and 80.8％,with significant difference (x2=14.185,P ＜0.05).The 5-year survival rates of Siewert type Ⅲ AEG patients with and without lymph node metastasis were 27.8％ and 75.0％,with significant difference (x2 =13.043,P ＜ 0.05).Conclusions For Siewert type Ⅱ AEG,lymph node metastasis is mostly seen in No.1,2,3,7,8a,110 lymph nodes,and followed by No.11,111 and 9 lymph nodes; for Siewert type Ⅲ AEG,lymph node metastasis is mostly seen in No.1,2,3,7,8a,4sb,11,4sa,4d lymph nodes,and then followed by No.9,10,5,6 lymph nodes. Key words: Adenocarcinoma of the esophagogastric junction; Siewert classification; Lymphatic metastasis; Lymph node dissection