Adenocarcinoma Of The Esophagogastric Junction Research Articles

Prognostic impact of sarcopenia in patients with locally advanced adenocarcinoma of the esophagogastric junction treated with neoadjuvant chemoradiotherapy.

Few studies have evaluated the significance of sarcopenia in predicting the outcomes of patients with adenocarcinoma of the esophagogastric junction (AEG), especially those who received neoadjuvant chemoradiotherapy (NCRT). We aimed to identify the sarcopenic status and its impact on the outcomes of patients with locally advanced AEG who received NCRT followed by radical surgery or systemic therapy. Patients with T3-4N+M0 AEG with accessible abdominal computed tomography (CT) before and after NCRT were retrospectively analyzed. Body composition parameters, particularly the skeletal muscle index (SMI), were assessed using a CT-based method, and sarcopenia was defined using a predetermined SMI cutoff value. Survival analysis was conducted using the Kaplan-Meier method. A Cox proportional hazards regression model was used to identify independent prognostic factors. Receiver operating characteristic curve analysis was carried out, and the area under the curve (AUC) was calculated to test the prognostic accuracy of different factors. A total of 63 patients were enrolled, 65.1 and 79.4% of whom developed pre- and post-NCRT sarcopenia, respectively. Patients with pre-NCRT sarcopenia had lower radical surgery rates (70.7 vs. 95.5%, p = 0.047) than those without sarcopenia; however, sarcopenic status did not affect other short-term outcomes, including treatment-related toxicity and efficacy. Pre-NCRT sarcopenia was identified as an independent predictive factor for poor overall survival (OS) [adjusted hazard ratio (HR), 6.053; p = 0.002] and progression-free survival (PFS) (adjusted HR, 2.873; p = 0.031). Compared with nutritional indices such as the Nutritional Risk Screening 2002, weight loss during NCRT, and post-NCRT sarcopenia, pre-NCRT sarcopenia was regarded as the best predictive index for the 5-year OS (AUC = 0.735) and PFS rates (AUC = 0.770). Pre-NCRT sarcopenia may be an independent predictive factor for OS and PFS rates in patients with locally advanced AEG receiving multimodal treatment.

Laparoscopic versus Open Approach for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction: A Systematic Review and Meta-Analysis

Introduction: Due to the specific location, the potential advantages of laparoscopic gastrectomy (LG) compared with open gastrectomy (OG) for Siewert II/III adenocarcinoma of the esophagogastric junction (AEG) remain uncertain. The current study aimed to compare the short- and long-term outcomes of LG versus OG in treating Siewert type II/III adenocarcinoma. Methods: We searched PubMed, Embase, Web of Science, MEDLINE (hosted by Ovid), and the Cochrane Library for publications till July 2022 and then used the RevMan 5.3 software for statistical analysis. Results: Ten publications from 10 medical centers were included, with 1,516 cases from the LG group and 1,219 from the OG group. Meta-analysis results showed that the LG group was superior to the OG group in intraoperative blood loss, hospital stay, lymph nodes retrieved, time to ambulation, time to first flatus, time to diet, 5-year overall survival, and 5-year disease-free survival. There was no significant difference between the two groups in operative time, overall complications, proximal margin, distal margin, pulmonary infection, anastomotic leakage, mortality, ileus, or absolute infection. Conclusions: Compared with OG, LG is associated with better surgical and long-term outcomes in Siewert type II/III AEG. LG is a safe and feasible option for treating Siewert type II/III AEG. However, studies with large sample sizes, long follow-up periods, and rigorous designs are needed for verification.

Can Clinical Stage in the 8th Edition of the Union for International Cancer Control TNM Classification Stratify the Prognosis of Patients Undergoing Curative Surgery for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction?

Clinical staging in the eighth edition of the Union for International Cancer Control TNM classification (TNM8) is reported to predict the prognosis of patients with gastric cancer. However, there have been no reports on using the TNM8 for prognostic stratification of patients with adenocarcinoma of the esophagogastric junction (AEG). This study aimed to investigate whether it was possible to stratify the prognosis of patients who underwent curative surgery for Siewert type II/III AEG according to the TNM8 clinical stage (cStage). This study included patients with Siewert type II/III AEG who underwent curative surgery between 2000 and 2019 at Kanagawa Cancer Center. Those who received neoadjuvant chemotherapy were excluded. We investigated the survival of patients with AEG of each TNM8 cStage. This study included 138 patients, among whom 102 (74%) had Siewert type II and 36 (26%) had Siewert type III AEG. A total of 50, 38, 43, and seven patients were classified with cStage I, II, III, and IV, respectively. The median duration of follow-up of the survivors was 54.7 months. The 5-year overall survival rate of the entire cohort was 65.8%, whereas for patients with cStage I, II, III and IV was 81.6%, 69.0%, 54.3% and 14.3%, respectively. The hazard ratio with reference to cStage I was 1.83, 3.07, and 8.13 for cStage I, III, and IV, respectively, increasing in a stepwise manner. TNM8 Clinical staging is able to stratify the prognosis of patients with Siewert type II/III AEG.

Should the splenic hilar lymph node be dissected for the management of adenocarcinoma of the esophagogastric junction?

Splenic hilar lymphadenectomy is not recommended for advanced proximal gastric cancer that does not invade the greater curvature according to the results of the previous studies. The efficacy of splenic hilar lymphadenectomy for type II and type III adenocarcinomas of the esophagogastric junction and easy spread to the greater curvature of the stomach remains unclear. This study aimed to investigate the efficacy of splenic hilar lymphadenectomy and identify the risk factors for metastasis to splenic hilar nodes. We examined patients who underwent R0/1 gastrectomy for Siewert types II and III at a single high-volume center in Japan. We analyzed the metastatic incidence, therapeutic value index, and risk factors for splenic hilar lymph node metastasis. We examined 126 patients (74, type II; 52, type III). Splenectomy was performed in 76 patients. Metastatic incidence and the therapeutic value index of splenic hilar lymph nodes in patients with type II and type III tumors were 4.5% and 0, and 21.9% and 9.4, respectively. In the patients who underwent splenectomy, we identified Siewert type III tumors (odds ratio: 6.93, 95% confidence interval: 1.24-38.8, p=0.027) and tumor location other than the lesser curvature (odds ratio: 7.36, 95% confidence interval: 1.32-41.1, p=0.023) to be independent risk factors. The metastatic incidence (46.2%) and therapeutic value index (15.4) were high in patients with both risk factors. Splenic hilar lymphadenectomy may contribute to the survival of patients with Siewert type III tumors, especially when the predominant location is not the lesser curvature.

Prognostic impact ofmicrometastasis in patients with esophageal cancer.

Squamous cell carcinoma (SCC) oftheesophagus and adenocarcinoma oftheesophago-gastric junction (AEG) are diseases with poor prognosis. Despite radical surgery having been carried out, many patients are at risk ofcancer recurrence, especially with thepresence ofmetastases in thelymph nodes. The study involved 60 patients suffering from SCC and AEG who had lymph nodes surgically removed between 2012 and 2018. Only lymph nodes with N0 status were subjected to immunohistochemistry examination. Histopathological criteria were used for thediagnosis ofmicrometastases (MM), defined as tumor cells or cell clusters of0.2-2 mm diameter in thelymph node and tumor cell microinvolvement defined as free-floating neoplastic cells or cell clusters within thesub-capsular sinus or intramedullary sinuses ofthelymph node. Atotal of1130 lymph nodes were removed during surgery, with an average of22 lymph nodes per patient (range 8-58). Micrometastases were found in 7 (11.66%) patients: 6 (10.0%) with AEG and 1 (1.66%) with SCC, representing astatistically significant difference p = 0.017. Multivariate analysis ofthestudy group did not confirm thedependence oftheMM on theT features ( p = 0.7) or G ( p = 0.5). In aCox regression analysis, MM were not arisk factor for death, HR: 2.57 (0.95; 7.00), p = 0.064. There was no difference in overall survival for patients with MM (N (+)) and those without (N0), p = 0.055, but there was astatistically significant difference in time ofrelapse between patients with and without MM ( p = 0.049). Patients with theN (+) status are at high risk ofcancer recurrence, and therefore we believe that complementary treatment should be considered in this group.

Exploration and optimization of surgical techniques for laparoscopic transhiatal lower mediastinal lymph node dissection for adenocarcinoma of esophagogastric junction: A prospective IDEAL 2a study with qualitative design.

To explore the change and feasibility of surgical techniques of laparoscopic transhiatal (TH)-lower mediastinal lymph node dissection (LMLND) for adenocarcinoma of the esophagogastric junction (AEG) according to Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) 2a standards. Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed. Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo IIIa. The surgical technique of laparoscopic TH-LMLND is stable and feasible; further IDEAL 2b research is warranted.

Influence of Primary Tumor Resection on Survival of Patients With Metastatic Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Population-Based, Propensity-Matched Analysis.

It remains unclear whether primary tumor resection improves survival in patients with metastatic Siewert type II adenocarcinoma of the esophagogastric junction (AEG). Therefore, our study attempted to investigate the prognostic value of primary tumor resection on metastatic AEG. In total, 4200 patients diagnosed with metastatic AEG were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Patients were categorized into two groups according to the performance of primary tumor resection. Pearson's chi-square test, Kaplan-Meier survival curve, and Cox regression analysis were conducted in this study. In addition, propensity-score matching was conducted to match 323 patients who received primary tumor resection and another 323 patients without. Multivariate Cox regression analysis demonstrated that primary tumor resection was a significant prognostic factor in patients with metastatic AEG before matching. Moreover, in the matched cohort, metastatic AEG patients receiving primary tumor resection had significantly longer overall survival (hazard ratio [HR]: .54, 95% confidence interval [CI]: .46-.64, P < .001) and cancer-specific survival (HR: .53, 95% CI: .45-.63, P < .001). Subgroup analysis similarly revealed that primary tumor resection was significantly associated with better survival in most subgroups. The present population-based study identified that primary tumor resection led to significantly superior survival in patients with metastatic AEG. These findings are likely to contribute to the development of individualized therapy in metastatic AEG.

Selection of two intrathoracic anastomosis methods for transabdominal radical surgery for Siewert type II adenocarcinoma of the esophagogastric junction.

The most common intrathoracic anastomosis techniques for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) are the overlap and transorally inserted anvil (OrVil) methods. However, the criteria for choosing between these two methods require further study. This retrospective study aimed to compare the efficacy and safety of overlap versus OrVil anastomosis in transabdominal radical surgery for Siewert type II adenocarcinoma of the esophagogastric junction. A total of 34 patients with Siewert type II AEG who underwent transabdominal radical surgery and intrathoracic anastomosis with the overlap or OrVil methods at our center from January 2018 to June 2019 were retrospectively analyzed. The relevant surgical and postoperative complication data of the two groups were collected and analyzed. Clinical characteristics: the mean tumor size was 7.5 ±2.4 cm in the OrVil group and 4.3 ±1.9 cm in the overlap group (p < 0.05). Surgery: the distance from the upper resection margin of the esophagus to the tumor was 3.2 ±0.84 cm in the OrVil group and 2.4 ±0.6 cm in the overlap group (p < 0.05). Postoperative complications: there were two cases of pleural effusion in the OrVil group and 18 cases of pleural effusion in the overlap group (p < 0.05). There is no significant difference between the OrVil and overlap anastomosis in terms of the feasibility and safety; however, OrVil anastomosis can provide a higher margin of resection of the esophagus and is suitable for tumors with extensive esophageal invasion.

Diagnostic performance of endoscopy for subsquamous extension of superficial adenocarcinoma of the esophagogastric junction

Objectives Extension of adenocarcinoma of the esophagogastric junction under the squamous epithelium may lead to errors when determining lateral margins. However, the characteristics of subsquamous extension are unclear. Herein, we evaluated the prevalence and characteristics of subsquamous extension of adenocarcinoma of the esophagogastric junction and the diagnostic performance of endoscopy for this condition. Methods Eighty-nine consecutive patients with superficial adenocarcinoma of the esophagogastric junction who underwent endoscopic or surgical resection at a tertiary cancer center between January 2010 and December 2017 were retrospectively evaluated. Endoscopic subsquamous extension was defined as a submucosal tumor-like elevation covered by squamous epithelium and/or a brownish area with abnormal microvessels on the squamous epithelium observed using narrow-band imaging. The diagnostic performance of endoscopy for subsquamous extension was evaluated using histological subsquamous extension as gold standard. Results Thirty-nine patients (44%) had histological subsquamous extension. Proton pump inhibitor use was significantly associated with histological subsquamous extension [odds ratio: 4.65; 95% confidence interval (CI): 1.77–12.2]. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of endoscopic subsquamous extension were 56% (95% CI: 40–72%), 96% (86–99%), 92% (73–99%), 74% (62–84%) and 79% (69–87%), respectively. The median length difference between histological and endoscopic subsquamous extension was 2 mm (range: −6 to 9 mm). Conclusions The sensitivity of endoscopic diagnosis of subsquamous extension was unsatisfactory. The endoscopic length of subsquamous extension tended to be underestimated. An oral safety margin of one centimeter is reasonable during endoscopic resection of adenocarcinoma of the esophagogastric junction. IMPACT STATEMENT This study will contribute significantly to the literature because this is the first study to determine the difference between the lengths of subsquamous extension detected endoscopically and histologically. This study determines the prevalence of subsquamous extension and identifies characteristics associated with subsquamous extension. An understanding of the risk of subsquamous extension is important when choosing a treatment strategy and planning the resection margins in patients with adenocarcinoma of the esophagogastric junction. This study provides patients with subsquamous extension characteristics and suggests a method for accurately diagnosing this condition.

ASO Author Reflections: The Role of Adjuvant Chemotherapy in Adenocarcinoma of the Esophagogastric Junction.

ASO Author Reflections: The Role of Adjuvant Chemotherapy in Adenocarcinoma of the Esophagogastric Junction.

Immunohistochemical Analysis of Nicotinamide Phosphoribosyltransferase Expression in Gastric and Esophageal Adenocarcinoma (AEG)

Nicotinamide phosphoribosyltransferase (NAMPT) represents a major component in cellular energy metabolism, which is also crucial for cancer cells that have elevated aerobic glycolysis; moreover, targeting the NAD salvage pathway by inhibition of NAMPT was shown effective in a subgroup of gastric cancer cell lines. In order to study the expression levels of NAMPT in adenocarcinoma of the esophagogastric junction and stomach (AEG/S) we performed immunohistochemical analysis in a cohort of 296 tumor samples using tissue-microarrays (TMAs). In the present investigation, we saw a high expression of NAMPT in only a minority of our large AEG/S cohort. Although we did not find a correlation between NAMPT expression and survival, subgroup analysis showed that NAMPT expression was more frequent in older patients (&gt;65 years, p = 0.049) and was associated with a numerical shorter survival that did not reach statistical significance within this age group. In conclusion, we did not find significance for any prognostic effect of NAMPT in our AEG/S cohort; however, the evaluation of other NAD metabolic enzymes is needed as molecular predictors of response to potential NAMPT inhibition in the treatment of patients with AEG/S.

Clinical and prognostic features of E-cadherin in adenocarcinoma of the esophagogastric junction patients.

The expression, activity, and functional role of E-cadherin in adenocarcinoma of the esophagogastric junction (AEG) are unclear. In this research, we evaluated the expression of E-cadherin in AEG, as well as its clinicopathological significance and prognostic value. A total of 65 AEG samples and 10 normal paracancerous tissues undergoing AEG resection in thoracic surgery were collected. The samples were immunohistochemically examined for expression levels of E-cadherin. The Chi-square test was used to determine if E-cadherin expression correlated with the clinicopathological features of AEG patients. The link between clinicopathological features and 5-year survival rates was investigated using Kaplan-Meier survival curves and multifactorial Cox regression analysis. In AEG tissues, E-cadherin expression was considerably reduced. Differentiation grade ( P = 0.013), infiltration depth ( P = 0.033), and clinicopathological stage ( P = 0.045) were substantially linked to the level of E-cadherin expression. Five-year survival rates of AEG patients were affected by E-cadherin expression ( P = 0.037), tumor differentiation ( P = 0.010), lymph node metastasis ( P < 0.001), and clinicopathological stage ( P = 0.037). Tumor differentiation ( P = 0.033) and lymph node metastasis ( P = 0.001) were independent risk factors for shorter overall survival. E-cadherin expression in AEG was significantly decreased, which was strongly related to tumor differentiation, infiltration, and clinicopathological stage. An E-cadherin deficiency would lead to poor prognosis in AEG patients. E-cadherin may play a crucial role in AEG invasion and metastasis. Low expression of E-cadherin may be a potential early biomarker and overall survival predictor for AEG patients.

Uncut interposed jejunum pouch versus esophago-gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach: An innovative method of digestive tract reconstruction following proximal gastrectomy

AimAn innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion. Methods118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed. ResultsThere were no significant differences in preoperative data among all groups (P > 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P < 0.05). The incidence of esophageal anastomotic stenosis in Uncut-D group was significantly lower than that in EG group (P < 0.05); In Uncut-D group, the incidence of reflux esophagitis, postoperative nutrition index(PNI), weight recovery and Visick classification were significantly better than those in EG group (P < 0.05), furthermore, the incidence of delayed gastric emptying,PNI and weight recovery were better than those in JI group (P < 0.05). ConclusionsThe Uncut-D procedure gave full play to jejunal continuity and the advantages of pouch, and played a valuable role in gastric and cardiac replacement, which significantly reduced long-term complications, improved postoperative nutritional status of patients and long-term quality of life.

Impact of examined lymph node number on accurate nodal staging and long-term survival of resected Siewert type II-III adenocarcinoma of the esophagogastric junction: A large population-based study.

We aimed to investigate the association between the number of examined lymph nodes (ELNs) and accurate nodal staging and long-term survival in Siewert type II-III Adenocarcinoma of the Esophagogastric Junction (AEG) by using large population-based databases and determined the optimal ELN number threshold. Data on Stage I-III Siewert type II-III AEG patients from 2010 to 2014 respectively from the United States (US) SEER database and a Chinese large medical center institutional registry were analyzed for correlation between the ELN number and stage migration (node negative-to-positive) and overall survival (OS) by using multivariable-adjusted logistic and Cox regression models, respectively. The series of odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural breakpoints were determined by Chow test. The selected optimal cut point was then validated with the 2015 to 2016 SEER database. Both the US cohort(n=1387) and China cohort(n=981) showed significantly increases from node-negative to node-positive disease (ORtheUS1.032,95%CI 1.017-1.046;ORChina1.034,95%CI 1.002-1.065) and enhancements in overall survival (HRtheUS0.970,95%CI 0.961-0.979;HRChina0.960,95%CI 0.940-0.980) with the increasing ELN number after controlling for confounders. Associations for both stage migration and overall survival were still significant in most subgroups' stratification. Cut point analysis showed a threshold ELN number of 18, which was validated both in the cohorts where it originated and in an independent SEER data cohort(n=379). More ELNs are associated with accurate nodal staging(negative-to-positive) as well as higher overall survival in resected Siewert types II-III AEG, We recommend 18 ELNs as the optimal cut point for the quality assessment of postoperative lymph node examination or prognostic stratification in clinical practice.

Safety and efficacy of preoperative indocyanine green fluorescence marking in laparoscopic gastrectomy for proximal gastric and esophagogastric junction adenocarcinoma (ICG MAP study).

The incidence of adenocarcinoma of the esophagogastric junction (AEG) and proximal gastric cancer (PGC) is rising worldwide. Recently, the use of indocyanine green (ICG) tracer-guided surgery has been reported; however, its efficacy for total/proximal gastrectomy has not been clarified. We evaluated the feasibility and safety of ICG fluorescent marking for tumor localization in AEG/PGC treatment by laparoscopic surgery. We enrolled patients with AEG/PGC from October 2016 to March 2019 from a prospectively registered database. On the day before surgery, ICG markings were made at four locations just at the edge of the tumor by gastrointestinal fiberscope examination. Surgery was performed while viewing the fluorescence image of ICG, and the proximal portions of the esophagus and the distal portion of the stomach were resected at the edge of the area where ICG had spread. We enrolled 130 patients with AEG/PGC. Overall, 107 patients were eventually included in the study: AEG n = 64 (60%) and PGC n = 43 (40%). ICG markings were detected intraoperatively in all cases, and cancer invasion into the resection lines of the esophagus and stomach, performed based on ICG fluorescence images, was negative in all cases. The median visible range of ICG fluorescence was 22.5mm. ICG diffusion expanded 20mm proximal for AEG. There were no adverse events associated with endoscopic ICG injection. ICG fluorescence imaging is feasible and safe and can potentially be used as a tumor-marking agent for determining the surgical resection line for total/proximal gastrectomy in AEG and PGC treatment.

Comparison of short-term surgical outcomes between complete mesenteric resection and traditional transhiatal laparoscopic surgery for Siewert type II/III esophagogastric junction adenocarcinoma.

To explore the effectiveness and safety of laparoscopic transhiatal complete mesenteric resection (CME) surgery compared with those of the traditional laparoscopic transhiatal approach in the treatment of Siewert II/III adenocarcinoma of the esophagogastric junction (AEG). Ninety-nine patients with Siewert type II/III AEG were enrolled and divided into two groups: the laparoscopic CME transhiatal approach (CEM-TH, n = 61) group and traditional laparoscopic transhiatal (TH, n = 38) group. Intraoperative and postoperative clinical data of both groups were analyzed. The laparoscopic trasihiatal surgery was technically successful in all patients. The surgical time, intraoperative bleeding, and hospital stay were all significantly (P < 0.05) reduced in the CME-TH group compared with those in the TH group. The levels of white blood cells on postoperative day (POD) 1 and 5, postoperative CRP on POD 3 and 5, and postoperative PCT were significantly (P < 0.05) lower while lymph nodes were harvested significantly (P < 0.05) more in the CME-TH group than in the TH group. Complications were not significantly (P > 0.05) different between two groups. No death occurred within 90days. The CME theory could be safely and effectively applied laparoscopically to treat patients with Siewert II/III AEG. Mesogastrium and lower mesoesophagus can be completely resected together with the tumor, lymph nodes, adipose tissue, and blood vessels as an "intact package," leading to better short-term outcomes.

Clinicopathological Significance of STAT3 and p-STAT3 among 91 Patients with Adenocarcinoma of the Esophagogastric Junction.

Adenocarcinoma of the esophagogastric junction (AEG) has increased rapidly worldwide during the last few decades. The purpose of this study is to investigate the clinical and prognostic characteristics of signal transduction and activator of transcription factor 3(STAT3) and phosphorylated STAT3 (p-STAT3) expression in AEG patients. We retrospectively analyzed the immunohistochemical results of 61 AEG patients and followed up for 5 years, while Western blot was performed on tissues from another 30 AEG patients. The results showed that STAT3 and p-STAT3 were overexpressed in AEG tissues (P < 0.05, P < 0.01). The high expression of STAT3 was significantly associated with the pTNM stage (P < 0.05), and the increased expression of p-STAT3 was significantly associated with depth of invasion (pT), lymph node metastasis (pN), and pTNM stage (P < 0.05, P < 0.05, P < 0.05). The 5-year survival rate for AEG patients was 41.0% and was significantly associated with tumor differentiation, pN, pTNM, and p-STAT3 (P < 0.05, P < 0.01, P < 0.05, P < 0.01). Cox regression analysis confirmed that tumor differentiation, pN, and high expression of p-STAT3 were independent risk factors for the 5-year survival rate in patients with AEG (P < 0.05, P < 0.01, P < 0.05). Our study showed that STAT3 and p-STAT3 play a critical role in AEG development.

Adenocarcinoma of the Esophagogastric Junction:Classification and Surgical Treatment Strategy

Despite substantial declines in gastric cancer incidence, the incidence of adenocarcinoma of the esophagogastricjunction (AEG) has been rising remarkably worldwide and is drawing considerable attention as well as concern.However, the optimal extent of esophagogastric resection for this tumor entity, especially Siewert type II tumorslocated at the true cardia, remains highly controversial. Given the uncertainty about the optimal extent of prophylactic lymph node dissection, both subtotal esophagectomy and extended total gastrectomy have been advocatedfor this tumor entity. A recent Japanese questionnaire-based national retrospective study showed that completenodal clearance along the distal portion of the stomach offered marginal survival benefits for patients with AEGless than 4 cm in diameter. A prospective nationwide multicenter study accurately identified the distribution oflymph node metastases from advanced AEG, suggesting that it is not recommended to completely dissect lymphnode stations along the distal portion of the stomach. Total gastrectomy might be employed less frequently andconsequently replaced by subtotal esophagectomy or extended proximal gastrectomy in clinical practice.

Health-related quality of life after super minimally invasive surgery and proximal gastrectomy for early-stage adenocarcinoma of the esophagogastric junction: a propensity score-matched study.

Health-related quality of life after super minimally invasive surgery and proximal gastrectomy for early-stage adenocarcinoma of the esophagogastric junction: a propensity score-matched study.

Efficacy of the No. 10 lymphadenectomy with spleen preservation on patients with gastric cancer and/or esophagogastric junction adenocarcinoma who underwent total gastrectomy: a systematic review and meta-analysis.

BackgroundSurgery with total gastrectomy and D2 lymph node dissection (LND) has been recommended as the standard treatment for patients with advanced upper and middle gastric carcinoma and/or Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG). However, whether the No. 10 lymph node (No. 10 LN, also known as splenic hilar LN) should be dissected in total gastrectomy remains controversial. We aimed to evaluate whether the No. 10 LND with spleen preservation has survival benefit for patients with gastric cancer and/or AEG who underwent the total gastrectomy.MethodsThe PubMed, Embase, the Cochrane Library, ClinicalTrials.gov and American Society of Clinical Oncology.org (ASCO.org) were electronically searched to identify eligible studies. The primary outcome was the survival rate, and secondary outcomes included the disease-free survival (DFS) rate and side effects. The Review Manager 5.3.5 software was used for the meta-analysis. The odds ratio (OR) and mean difference with 95% confidence interval (CI) were calculated. The statistical heterogeneity was assessed using chi-square (χ2) and I2 tests.ResultsEight studies enrolling a total of 4,131 patients were eligible for our review. The meta-analysis results demonstrated that the No. 10 LND group was significantly better than the non-No. 10 LND group in terms of the 3- (OR =0.71, 95% CI: 0.62–0.81, P<0.00001) and the 5-year (OR =0.66, 95% CI: 0.58–0.75, P<0.00001) survival rates but not in the 1-year survival rate (OR =0.91, 95% CI: 0.75–1.11, P=0.36). The DFS rates in the No. 10 LND group were significantly increased after 1 (OR =0.76, 95% CI: 0.61–0.93, P=0.008), 3 (OR =0.69, 95% CI: 0.60–0.81, P<0.00001), and 5 (OR =0.66, 95% CI: 0.56–0.76, P<0.00001) years compared with those in the non-No. 10 LND group.DiscussionEvidence shows that the No. 10 LND with spleen preservation can improve the survival and the DFS rates for patients with gastric cancer and/or Siewert type II/III AEG who underwent the total gastrectomy. High-quality prospective trials are expected.