Abstract

We aim to evaluate whether resected lymph nodes (RLNs) numbers have prognostic value in patients with gastroesophageal junction cancers (GEJ, Siewert type II). Patients with gastroesophageal junction cancers were identified from the Surveillance Epidemiology and End Results (SEER) registry between 1988 to 2013. Multivariate Cox regression analyses and Kaplan–Meier method were performed to analyze risk factors for overall survival (OS) and cause-specific survival(CSS). A total of 8396 patients who underwent surgeries and had reginal lymph nodes examined were identified. Kaplan–Meier analysis indicated that more numbers of resected lymph nodes (RLNs) were associated with better survival. The five-year OS rates for 1–20 and 21–90 RLNs were 26.8% and 32.4%, with a median survival time of 62 and 72 months, respectively (P < 0.001). The five-year CSS rates were 32.2% and 37.2% in each group, with median survival time of 90 and 101 months, respectively (P < 0.001). Cox regression multivariate analysis showed that year of diagnosis, age, sex, marital status, grade, seer histology, tumor histology, lymph node ratio (LNR) and RLNs as a categorical variable were all significant prognostic factors for both OS and CSS. RLN count is an independent prognostic factor for Siewert type II GEJ cancer patients and patients can achieve better overall and cancer-specific survival with more than 20 RLNs dissected.

Highlights

  • Gastroesophageal junction (GEJ) malignancies are among the most common cancer-caused mortality worldwide

  • We aim to evaluate whether resected lymph nodes (RLNs) numbers have prognostic value in patients with gastroesophageal junction cancers (GEJ, Siewert type II)

  • We aim to demonstrate whether resected lymph nodes numbers have prognostic value in Siewert type II cancer patients and evaluate the potential effect of lymph node status and Lymph Node Ratio (LNR) on the overall and cancer-specific survival by using The Surveillance, Epidemiology, and Results (SEER) database

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Summary

Introduction

Gastroesophageal junction (GEJ) malignancies are among the most common cancer-caused mortality worldwide. 1.4 million new GEJ cancers are diagnosed every year globally [1]. Its location ranges from the distal esophagus to the proximal stomach. The GEJ cancers could be divided into 3 subtypes: type I GEJ cancers are 1cm to 5cm above the GEJ, while type II and type III cancers are 1cm to 2cm and 2cm to 5cm below the GEJ, respectively [3]. The 5-year survival for GEJ cancers were 30% with only surgery, which might be attributed to the high recurrence rate of this malignancy and its metastatic potential [4]. As the treatment of gastric cancers is different from that of esophageal cancer, the specific treatment for GEJ cancers remains controversial

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