Diffuse-Type Histology Is Prognostic for All Siewert Types of Gastroesophageal Adenocarcinoma.

IF 3.2 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastric Cancer Pub Date : 2024-07-01 DOI:10.5230/jgc.2024.24.e20

Kelly M Mahuron, Kevin M Sullivan, Matthew C Hernandez, Yi-Jen Chen, Joseph Chao, Laleh G Melstrom, I Benjamin Paz, Jae Yul Kim, Rifat Mannan, James L Lin, Yuman Fong, Yanghee Woo

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引用次数: 0

Abstract

Purpose: The optimal treatment for gastroesophageal junction adenocarcinoma (GEJA) remains controversial. We evaluated the treatment patterns and outcomes of patients with locally advanced GEJA according to the histological type.

Materials and methods: We conducted a single-institution retrospective cohort study of patients with locally advanced GEJA who underwent curative-intent surgical resection between 2010 and 2020. Perioperative therapies as well as clinicopathologic, surgical, and survival data were collected. The results of endoscopy and histopathological examinations were assessed for Siewert and Lauren classifications.

Results: Among the 58 patients included in this study, 44 (76%) were clinical stage III, and all received neoadjuvant therapy (72% chemoradiation, 41% chemotherapy, 14% both chemoradiation and chemotherapy). Tumor locations were evenly distributed by Siewert Classification (33% Siewert-I, 40% Siewert-II, and 28% Siewert-III). Esophagogastrectomy (EG) was performed for 47 (81%) patients and total gastrectomy (TG) for 11 (19%) patients. All TG patients received D2 lymphadenectomy compared to 10 (21%) EG patients. Histopathological examination showed the presence of 64% intestinal-type and 36% diffuse-type histology. The frequencies of diffuse-type histology were similar among Siewert groups (37% Siewert-I, 36% Siewert-II, and 33% Siewert-III). Regardless of Siewert type and compared to intestinal-type, diffuse histology was associated with increased intraabdominal recurrence rates (P=0.03) and decreased overall survival (hazard ratio, 2.33; P=0.02). With a median follow-up of 31.2 months, 29 (50%) patients had a recurrence, and the median overall survival was 50.5 months.

Conclusions: Present in equal proportions among Siewert types of esophageal and gastric cancer, a diffuse-type histology was associated with high intraabdominal recurrence rates and poor survival. Histopathological evaluation should be considered in addition to anatomic location in the determination of multimodal GEJA treatment strategies.

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弥漫型组织学对所有 Siewert 型胃食管腺癌都有预后意义

目的：胃食管连接部腺癌（GEJA）的最佳治疗方法仍存在争议。我们根据组织学类型评估了局部晚期 GEJA 患者的治疗模式和结果：我们对 2010 年至 2020 年间接受治愈性手术切除的局部晚期 GEJA 患者进行了单机构回顾性队列研究。研究收集了围手术期的治疗方法以及临床病理、手术和生存数据。对内镜检查和组织病理学检查结果进行评估，以确定Siewert和Lauren分类：58例患者中，44例（76%）为临床Ⅲ期，全部接受了新辅助治疗（72%化疗，41%化疗，14%同时接受化疗和化疗）。肿瘤位置按Siewert分类均匀分布（33%为Siewert-I期，40%为Siewert-II期，28%为Siewert-III期）。47例（81%）患者接受了食管胃切除术（EG），11例（19%）患者接受了全胃切除术（TG）。所有 TG 患者都接受了 D2 淋巴腺切除术，而 EG 患者只有 10 例（21%）。组织病理学检查显示，肠型组织学占 64%，弥漫型组织学占 36%。弥漫型组织学在 Siewert 组别中的出现频率相似（37% Siewert-I、36% Siewert-II 和 33% Siewert-III）。无论Siewert类型如何，与肠型相比，弥漫型组织学与腹腔内复发率增加（P=0.03）和总生存率下降（危险比2.33；P=0.02）有关。中位随访31.2个月，29例（50%）患者复发，中位总生存期为50.5个月：结论：弥漫型组织学与高腹腔内复发率和低生存率有关。在确定胃食管癌多模式治疗策略时，除了解剖位置外，还应考虑组织病理学评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastric Cancer Biochemistry, Genetics and Molecular Biology-Cancer Research

CiteScore

4.30

自引率

12.00%

发文量

期刊介绍： The Journal of Gastric Cancer (J Gastric Cancer) is an international peer-reviewed journal. Each issue carries high quality clinical and translational researches on gastric neoplasms. Editorial Board of J Gastric Cancer publishes original articles on pathophysiology, molecular oncology, diagnosis, treatment, and prevention of gastric cancer as well as articles on dietary control and improving the quality of life for gastric cancer patients. J Gastric Cancer includes case reports, review articles, how I do it articles, editorials, and letters to the editor.