Differences in prognosis of Siewert II and III oesophagogastric junction cancers are determined by the baseline tumour staging but not its anatomical location
Introduction
The incidence of adenocarcinoma of the oesophagogastric junction (OGJ) has increased over the past decades in most Western countries, probably causally associated with the prevalence of smoking, obesity and reflux disease.1, 2 While the tendency regarding proximal migration of gastric cancers seems to be stabilizing in some European territories, the incidence of OGJ adenocarcinoma continues to rise in the USA.3, 4 Therefore, this type of malignancy remains a significant clinical challenge in most geographic areas.5, 6
OGJ cancers are biologically aggressive tumours with the overall 5-year survival rates of about 18–38% following curative surgery.7, 8 Traditionally, anatomical location of the tumour defined by the Siewert classification is considered as one of the principal factors determining selection of surgical treatment.9, 10 However, the anatomical complexity of these tumours also implies many challenges for both diagnosis and treatment. Consequently there are some uncertainties whether the Siewert classification in the era of modern combined modality treatments is still of clinical value.11 This is particularly relevant for type II and III tumours that share some common clinical and pathological features, and could potentially follow the same therapeutic algorithms. However, application of different classification systems hamper the generalizability of results obtained from various geographic locations to daily surgical practice.
Considering the existing discrepancies in previous reports, the aim of this study was to compare short- and long-term outcomes of treatment for type II and III OGJ adenocarcinomas, using a well defined multi-institutional data set of Western patients classified according to the most recent guidelines of the TNM system.12
Section snippets
Methods
An electronic database of all patients with resectable gastric cancer treated between 1998 and 2008 at seven university surgical centres cooperating in the Polish Gastric Cancer Study Group (PGCSG) was reviewed to identify tumours of the oesophagogastric junction. Type II tumours were defined as adenocarcinoma within 1 cm above and 2 cm below the junction, while type III cancers included cases of adenocarcinoma within 2–5 cm below the junction.9 All relevant data, including demographics,
Clinicopathological characteristics
A total of 2398 patients with resectable gastric cancer were identified in the PGCSG database between 1998 and 2008, including 109 patients with Siewert type II and 134 with Siewert type III adenocarcinoma of the oesophagogastric junction that constituted the final population of this study (Table 1). There were 172 males and 71 females with a median age of 63 years (IQR 53–70). Both groups showed similar characteristics with respect to clinical factors, such as age, gender, comorbidities, ASA
Discussion
Potential differences in biological behaviour of Siewert type II and III adenocarcinomas of the oesophagogastric junction may have important clinical implications. However, in a well-defined population of Western patients undergoing gastric resections for OGJ cancers we have demonstrated that the anatomical location of the tumour was associated with some differences in the locoregional extent of the disease, but did not influence the short- and long-term outcomes.
The Siewert classification for
Conflict of interest statements
The authors declare that they have no conflicts of interest.
Ethics committee approval
This study was approved by the Bioethics Committees at each institution.
Role of funding source
This study was financially supported by the Polish State Committee for Scientific Research, Grants no. N N403 069 31/3255 and N N403 038839.
The funding source did not participate in study design, collection, analysis, or interpretation of the data, or writing of the report.
Acknowledgements
Other Members of the Polish Gastric Cancer Study Group:
R. Bandurski, A. Dabrowski, J. Dadan, M. Drews, H. Jaroszewicz-Heigelmann, A. Jeziorski, M. Fraczek, M. Krawczyk, T. Starzynska, B. Stawny, A.M. Szczepanik, G. Wallner, K. Wronski.
References (26)
- et al.
Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease
Semin Radiat Oncol
(2013) - et al.
Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands
Eur J Cancer
(2010) - et al.
Does the Incidence of adenocarcinoma of the esophagus and gastric cardia continue to rise in the twenty-first century? – a SEER Database analysis
J Gastrointest Surg
(2014) - et al.
Systematic review of the surgical strategies of adenocarcinomas of the gastroesophageal junction
Surg Oncol
(2014) - et al.
Status and prognosis of lymph node metastasis in patients with cardia cancer – a systematic review
Surg Oncol
(2014) - et al.
The pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction
Surgery
(2001) - et al.
Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors
J Am Coll Surg
(2005) - et al.
Epidemiology of adenocarcinoma of the esophagus, gastric cardia, and upper gastric third
Recent Results Cancer Res
(2010) - et al.
Treatment approaches to esophagogastric junction tumors
Dig Surg
(2013) Esophagogastric junction and gastric adenocarcinoma: neoadjuvant and adjuvant therapy, and future directions
Oncology (Williston Park)
(2014)