Gastric Junction Adenocarcinoma Research Articles

Comparative study on the expression of Pax3, Rad51 and VEGF-C in esophageal gastric junction adenocarcinoma and distal gastric adenocarcinoma.

The purpose of this study was to explore the differential expression of Pax3, Rad51 and VEGF-C in esophageal gastric junction adenocarcinoma and distal gastric adenocarcinoma and their relationship with cancer occurrence and development. 57 patients with gastric cancer were included and divided into esophageal gastric junction adenocarcinoma group (n=28) and distal gastric adenocarcinoma group (n=29). The positive expressions of Pax3, Rad51 and VEGF-C in the control group were lower than those in the esophageal gastric junction adenocarcinoma group and distal gastric adenocarcinoma group respectively (P<0.05). In esophageal gastric junction adenocarcinoma with low differentiation, positive expressions of Pax3, Rad51, and VEGF-C surpassed those in high/medium differentiation (P<0.05). Serosa-infiltrated cases exhibited higher Pax3 and Rad51 expressions compared to non-infiltrated cases (P<0.05). Rad51 and VEGF-C positivity were notably elevated in cases with lymph node metastasis compared to those without (P<0.05). Distal gastric adenocarcinoma displayed higher VEGF expression than middle/low differentiated adenocarcinomas. Rad51 expression was significantly higher in women than in men (P<0.05). The positive rates of Pax3, Rad51, and VEGF-C were markedly increased in esophageal gastric junction adenocarcinoma and distal gastric adenocarcinoma compared to normal gastric tissue, and these were associated with the degree of differentiation, depth of invasion, and lymph node metastasis in patients. Particularly, Rad51 exhibited a positive correlation with cancer cell differentiation, invasion depth, and lymph node metastasis in cancer tissue.

[Feasibility of a single-port thoracoscopy-assisted five-step laparoscopic procedure via transabdominal diaphragmatic approach for No.111 lymphadenectomy in patients with Siewert type II esophageal gastric junction adenocarcinoma].

Objective: We aimed to explore the feasibility of a single-port thoracoscopy- assisted five-step laparoscopic procedure via transabdominal diaphragmatic(TD) approach(abbreviated as five-step maneuver) for No.111 lymphadenectomy in patients with Siewert type II esophageal gastric junction adenocarcinoma (AEG). Methods: This was a descriptive case series study. The inclusion criteria were as follows: (1) age 18-80 years; (2) diagnosis of Siewert type II AEG; (3) clinical tumor stage cT2-4aNanyM0; (4) meeting indications of the transthoracic single-port assisted laparoscopic five-step procedure incorporating lower mediastinal lymph node dissection via a TD approach; (5) Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1; and (6) American Society of Anesthesiologists classification I, II, or III. The exclusion criteria included previous esophageal or gastric surgery, other cancers within the previous 5 years, pregnancy or lactation, and serious medical conditions. We retrospectively collected and analyzed the clinical data of 17 patients (age [mean ± SD], [63.6±11.9] years; and 12 men) who met the inclusion criteria in the Guangdong Provincial Hospital of Chinese Medicine from January 2022 to September 2022. No.111 lymphadenectomy was performed using five-step maneuver as follows: superior to the diaphragm, starting caudad to the pericardium, along the direction of the cardio-phrenic angle and ending at the upper part of the cardio-phrenic angle, right to the right pleura and left to the fibrous pericardium , completely exposing the cardio-phrenic angle. The primary outcome includes the numbers of harvested and of positive No.111 lymph nodes. Results: Seventeen patients (3 proximal gastrectomy and 14 total gastrectomy) had undergone the five-step maneuver including lower mediastinal lymphadenectomy without conversion to laparotomy or thoracotomy and all had achieved R0 resection with no perioperative deaths. The total operative time was (268.2±32.9) minutes, and the lower mediastinal lymph node dissection time was (34.0±6.0) minutes. The median estimated blood loss was 50 (20-350) ml. A median of 7 (2-17) mediastinal lymph nodes and 2(0-6) No. 111 lymph nodes were harvested. No. 111 lymph node metastasis was identified in 1 patient. The time to first flatus occurred 3 (2-4) days postoperatively and thoracic drainage was used for 7 (4-15) days. The median postoperative hospital stay was 9 (6-16) days. One patient had a chylous fistula that resolved with conservative treatment. No serious complications occurred in any patient. Conclusion: The single-port thoracoscopy-assisted five-step laparoscopic procedure via a TD approach can facilitate No. 111 lymphadenectomy with few complications.

[Analysis of survival and prognosis of Siewert Ⅱ/Ⅲ esophagogastric junction adenocarcinoma patients with non-operative acute upper gastrointestinal hemorrhage].

Objective: To analyze the clinical characteristics and risk factors of non-operative acute upper gastrointestinal hemorrhage in patients with adenocarcinoma of the esophagogastric junction. Methods: The clinical diagnosis and treatment data of patients with adenocarcinoma of esophagogastric junction with non-operative acute upper gastrointestinal hemorrhage admitted to Cancer Hospital of Chinese Academy of Medical Sciences from 2004 to 2018 were collected retrospectively, and the survival of patients was followed up by telephone. SPSS software was used for database establishment and analysis. Cox proportional-hazards model was applied to analyse the survival and related risk factors. Results: A total of 70 patients were included in this study, with a median age of 65 (20-81 years). The ratio of male to female is 2.18∶1. There were 36 cases of Siewert type Ⅱ (51.4%) and 34 cases of Siewert type Ⅲ (48.6%). The lymph node metastasis rates of Siewert Ⅱ and Siewert Ⅲ were 75.0% and 94.1%, respectively (P=0.028). The median overall survival time (OS) of all 70 patients was 11.6 months. The median OS of Siewert Ⅱ and Siewert Ⅲ were 20.0 months and 8.5 months, respectively, and the 1-year survival rates were 42% and 9%, respectively (P=0.027). The median OS of M0 and M1 patients were 19.1 and 7.7 months, respectively, and the 1-year survival rates were 40% and 4%, respectively (P=0.049). The median OS of the treatment of operation+chemotherapy, chemotherapy or best supportive care after hemorrhage were 60.0, 22.2, and 7.9 months, respectively, and the 1-year survival rates were 89%, 45%, and 2%, respectively (all P<0.05). Multivariate analysis showed that Siewert Ⅲ (HR=1.965, 95%CI: 1.078-3.583), M1 stage (HR=1.787, 95%CI: 1.002-3.187) and operation+chemotherapy treatment after hemorrhage (HR=0.132, 95%CI:0.032-0.552) were independent prognostic factors for patients of esophagogastric junction adenocarcinoma with non-operative acute upper gastrointestinal hemorrhage. Conclusions: The survival of patients of esophageal gastric junction adenocarcinoma with non-operative acute upper gastrointestinal hemorrhage is poor, especially for patients of Siewert Ⅲ and the late stage. Active operation and chemotherapy after bleeding may positively affect the survival of these patients.

Clinical and Therapeutic Implications of the 8th Edition TNM Classification of Adenocarcinomas of the Esophagogastric Junction.

The 8th edition of TNM cancer staging is based on data from large patient cohorts, data collected from the Worldwide Collaboration Cancer Esophageal (WECC) group, or the International Association for Gastric Cancer (IGCA), including treated patients surgically per primate or after neoadjuvant treatment. This edition redefines the esophago-gastric junction tumors and recommends different TNMs staging: Siewert type I and II should be classified according to TNM recommendations for esophageal adenocarcinoma, while for Siewert type III the TNM classification for gastric cancer should be considered. Anatomical characteristics feature type T (tumor invasion), type N (regional lymph node invasion) and type M (distant metastasis). Non-anatomic characteristics include tumor differentiation (G) and tumor localization (L). Category descriptors are currently evaluated by endoscopy with biopsy, fine needle aspiration (EUS-FNA), thoraco-abdomino-pelvic computer tomography (CT) and positron emission tomography (CT-PET). The new TNM staging edition presents separate classifications applicable for therapeutic strategy: clinical staging cTNM (prior to any treatment), pathological staging pTNM (after surgery first) and neoadjuvant pathologic staging ypTNM (after neoadjuvant treatment followed by surgery). The refinement of each category and subcategory of T, N, M makes the 8th edition more accurate and adaptable to current practice, including for therapeutic strategy. The purpose of this study is to evaluate the clinical and therapeutical implications of the 8th edition of the TNM staging for esophago gastric junction adenocarcinoma.

Clinical and pathological features of esophageal and gastric junction adenocarcinoma and current status of postoperative adjuvant chemoradiotherapy

The incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising rapidly in recent years. AEG as an independent disease different from squamous cell carcinoma of the esophagus and gastric adenocarcinoma is getting acknowledged for most of scholars, with the distinctive anatomy location and involute recurrence and metastasis style. A higher rate of relapse and poor prognosis after resection become conscious since most of patients have been diagnosed with advanced disease, and adjuvant chemoradiotherapy needs to be valued further. But so far, there is no clinical data and subgroup analysis aimed at the value of postoperative treatment for AEG specially, leading to controversy is remaining in patients could get benefit from postoperative treatment, and delineation of the radiation target, etc. The design of the irradiation target should in terms of the clinical-pathological characteristics of the AEG, Siewert’s subtypes, the lymph node metastasis mapping and recurrence characteristics after surgery. Key words: Adenocarcinoma of the esophagus and stomach/postoperative adjuvant radiochemotherapy; Clinical pathological characteristics

[Trastuzumab combined with chemotherapy in patients with HER2-positive chemo-refractory advanced gastric or gastro-esophageal junction adenocarcinoma].

To evaluate the efficacy and safety of trastuzumab combined with chemotherapy in the treatment for HER-2-positive chemo-refractory advanced gastric or gastro-esophageal junction adenocarcinoma. Twenty consecutive cases of chemo-refractory advanced gastric or gastro-esophageal junction adenocarcinoma treated in Peking University Cancer Hospital between 2009 June and 2013 August were included in this study. The patients with adenocarcinoma were previously confirmed and were eligible if their tumor showed overexpression of HER-2+++ by immunohistochemistry or HER-2 gene amplification-positive by FISH, and if they failed to at least one previous chemotherapy. Response and toxicities were evaluated with RECIST 1.0 and CTC AE 3.0 criteria. The twenty patients received trastuzumab plus second- or later-line chemotherapy, consisting of nine platinum with fluoropyrimidines, five paclitaxel with fluoropyrimidines, three fluoropyrimidines monotherapy, two irinotecan monotherapy, and one docetaxel monotherapy. In these 20 cases, 3 PR (15.0%) and 10 SD (50.0%) were achieved, with a disease control rate of 65.0%. The median PFS was 6.1 months (95%CI 3.0-9.2) and median OS was 11.1 months (95%CI 8.4-13.7). The median cycle number of Trastuzumab administration was 6.5. The patients treated with Trastuzumab ≥ 6 times had a median OS of 13.8 months, significantly longer than that of 9.5 months in the patients treated <6 times (P < 0.001). The patients treated with Trastuzumab ≥ 6 times had a median PFS of 7.8 months, significantly longer than that of 3.7 months in patients treated <6 times (P = 0.029). Among the 20 cases, loss of appetite (13 cases of grade 1-2), neutropenia (12 cases of grade 1-2 and 3 cases of grade 3-4) and fatigue (9 cases of grade 1-2 and 3 cases of grade 3-4) were the most frequent adverse events. No cardiac events including asymptomatic decreases in LVEF ≥ 10% and no treatment-related death were recorded. Combination of trastuzumab with chemotherapy is effective and safe in patients with HER2-positive advanced chemo-refractory gastric or gastro-esophageal junction adenocarninoma. However, prospective studies are warranted to further confirm its efficacy and safety.

Bevacizumab Falls Short in Treating Advanced Gastric Cancer

The effectiveness of multiagent chemotherapy is limited in advanced gastric cancer: <50% of patients respond to treatment, and survival is usually <1 year. To assess whether adding the antiangiogenic agent bevacizumab to chemotherapy would improve overall survival (OS) in this setting, investigators conducted a multinational, randomized, double-blind, placebo-controlled phase III trial (AVAGAST) involving 774 patients with metastatic gastric or gastroesophageal junction adenocarcinoma. Patients …

Reproductive and sex hormonal factors and oesophageal and gastric junction adenocarcinoma: A pooled analysis

Background The rapidly rising incidence and the striking male predominance are as yet unexplained features of oesophageal and gastric junction adenocarcinoma. Few and underpowered studies have examined the impact of female reproductive factors on risk of these adenocarcinomas in women. We therefore pooled data on women from four population-based case-control studies to examine the association of female reproductive and sex hormonal factors with oesophageal and gastric junction adenocarcinoma. Methods Data on women from case-control studies conducted in Ireland, the United Kingdom (UK), Australia and United States of America (USA) were pooled. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for a range of reproductive factors, adjusted for age, study and major risk factors for oesophageal and gastric junction adenocarcinoma. Results We included 218 cases and 862 controls. Among parous women, a reduced risk of oesophageal and gastric junction adenocarcinoma was found after breastfeeding (OR = 0.58, 95% CI = 0.37–0.92) and the risk decreased with increased duration of breastfeeding (>12 months OR = 0.42, 95% CI = 0.23–0.77). The endogenous reproductive factors such as parity, menstruation, history of pregnancy and the exogenous factors such as use of oral contraceptives and of hormone replacement therapy were not statistically significantly associated with oesophageal and gastric junction adenocarcinoma. Conclusion Our findings suggest that breastfeeding is associated with a decreased risk of oesophageal and gastric junction adenocarcinoma. The potential mechanism of this association warrants further investigation.