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RESEARCH Open Access Clinicopathological characteristics
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Ito et al Journal of Experimental Clinical Cancer Research 2013 32 2 Page 2 of 12. http www jeccr com content 32 1 2, Figure 1 Tumor classification We categorized tumors near the EGJ into four types according to its location and main histological type. Categorization criteria were i squamous cell carcinoma with epicenter in the esophagus within 5 cm from EGJ type E SQ ii. adenocarcinoma with epicenter in the esophagus within 5 cm from EGJ type E AD iii any histological tumor with epicenter in the stomach. within 5 cm from EGJ with EGJ invasion type Ge iv any histological tumor with epicenter in the stomach within 5 cm from EGJ without EGJ. invasion type G Type E SQ E AD and Ge tumors were categorized as esophageal cancer type G tumor was categorized as gastric cancer by. the American Joint Committee on Cancer International Union Against Cancer AJCC UICC Cancer Staging Manual Siewert type I and III tumors. were categorized as type E AD and Ge tumors and Siewert type II tumor was categorized as type E AD or Ge tumor in this study. in the lower esophagus it can be treated as lower squamous cell carcinoma and adenocarcinoma centered. esophageal cancer whereas type III tumor has similar in the esophagus within 5 cm and in the proximal 5 cm. clinicopathological characteristics to cardiac cancer be of the stomach with crossing the EGJ 6 7 AJCC UICC. cause of its location However Siewert type II tumor is a also categorizes any cardiac cancer without EGJ invasion. metastatic threat to both thoracic and abdominal areas as gastric cancer regardless of its location Different sta. as it crosses the EGJ Subtotal esophagectomy offers only ging systems are applied to esophageal squamous cell. a limited benefit and should not be performed for type carcinoma and esophageal adenocarcinoma. II cancer The TNM staging system according to the sev Surgery is effective treatment for resectable esophageal. enth edition of the American Joint Committee on Can 8 9 and gastric cancer 10 12 However as esophagect. cer International Union Against Cancer AJCC UICC omy is generally more invasive than gastrectomy 13 we. Cancer Staging Manual defined EGJC including of should be careful in treating EGJC with esophagectomy. Figure 2 Flow diagram of the patients in this study Total 92 patients who underwent curative surgical resection for esophagogastric. junctional cancer at the Digestive Disease Center Showa University Northern Yokohama Hospital between October 2001 and December 2010. were retrospectively studied, Ito et al Journal of Experimental Clinical Cancer Research 2013 32 2 Page 3 of 12. http www jeccr com content 32 1 2, Table 1 Patient characteristics n 92. Age year mean SD 65 9 9 4, Sex Male 72 78 3, Female 20 21 7. Siewert classification Type I adenocarcinoma 2 2 2. Type II adenocarcinoma 16 17 4, Type III adenocarcinoma 11 12 0.
Not applicable 63 68 5, Macro type Type 0 36 39 1, Type 1 4 4 3. Type 2 26 28 3, Type 3 21 22 8, Type 4 1 1 1, Type 5 4 4 3. Preoperative chemotherapy No 79 85 9, Yes 13 14 1, Extent of surgical resection Subtotal esophagectomy with partial gastrectomy 14 15 2. Proximal gastrectomy with partial esophagectomy 30 32 6. Total gastrectomy with partial esophagectomy 48 52 2. Extent of lymph node dissection Abdominal mediastinal and cervical 11 12 0. Abdominal and mediastinal 9 9 8, Abdominal and lower mediastinal 27 29 3. Abdominal 45 48 9, Pathological tumor size mm mean SD 46 1 23 7.
Main histologic type Adenocarcinoma 79 85 9, Squamous cell carcinoma 13 14 1. Lymphatic invasion L0 32 34 8, L1 60 65 2, Venous invasion V0 32 34 8. V1 2 60 65 2, Pathological depth of tumor invasion pT1 33 35 9. pT2 11 12 0, pT3 35 38 0, pT4 13 14 1, Lymph node metastasis pN0 47 51 1. pN1 19 20 7, pN2 14 15 2, pN3 12 13 0, Distant metastasis pM0 72 78 3.
pM1 20 21 7, TNM stage pStage I 36 39 1, pStage II 19 20 7. pStage III 17 18 5, pStage IV 20 21 7, Ito et al Journal of Experimental Clinical Cancer Research 2013 32 2 Page 4 of 12. http www jeccr com content 32 1 2, Table 1 Patient characteristics n 92 Continued. Adjuvant chemotherapy No 43 46 7, Yes 49 53 3, Including lower thoracic paraesophageal diaphragmatic and posterior mediastinal lymph node. We studied clinicopathological characteristics of patients type G All disease was pathologically staged using the. with EGJC to investigate its optimal management seventh edition of AJCC UICC TNM Cancer Staging. Manual 6 7 Thus types E and Ge tumors were staged, Methods as esophageal cancer and type G tumor was staged as.
Study design gastric cancer, We performed a single center retrospective cohort study. We studied patients who underwent curative surgery for Statistical analysis. EGJC including lymph node dissection at the Digestive Statistical analysis was performed using JMP 9 0 3 SAS. Disease Center Showa University Northern Yokohama Institute Cary USA We used Fisher s exact test and. Hospital between October 2001 and December 2010 Pearson s chi squared test to compare the characteristics. Clinicopathological data and prognosis were taken from of the patients and pathological findings The nonpara. medical records metric Kruskal Wallis test was used to assess differences. among patients age groups number of dissected lymph. nodes and pathological tumor size Kaplan Meier curves. of estimated overall survival were generated and com. We studied patients with cancer in the lower esophagus. pared using a 2 sided log rank test To investigate prog. and cardia Inclusion criteria were i presence of histolo. nostic factors Cox proportional hazard analysis was. gically proven carcinoma centered within the lower 5 cm. used Multivariate analysis included tumor types and. of the esophagus and the upper 5 cm of the stomach ii. variables with P 0 10 in univariate analysis P 0 05. clinically solitary tumors iii no prior endoscopic resec. was considered statistically significant, tion or surgical treatment and iv patient aged 20. 80 years The exclusion criteria were i presence of severe. organ dysfunction ii presence of metachronous and syn. Patient characteristics, chronous malignancy and iii presence of pathological. A total of 92 patients were included in this study. non curative findings, Figure 2 Median follow up of surviving patients was. All patient data were approved for use by the institu 35 5 months Patients characteristics are summarized in. tional review board of Showa University Northern Table 1 Approximately 80 of them were men their. Yokohama Hospital This study was registered with the average age was 65 9 years range 35 80 years Four. University Hospital Medical Information Network in teen 15 2 30 32 6 and 48 52 2 patients under. Japan No UMIN000008596 went subtotal esophagectomy with partial gastrectomy. proximal gastrectomy with partial esophagectomy and. Classification total gastrectomy with partial esophagectomy respect. Although Siewert classification is one of the most widely ively Twenty four patients underwent splenectomy to. used criteria for EGJC it is generally used for only remove involved lymph nodes at the splenic hilum Thir. adenocarcinoma EGJC including squamous cell carcin teen patients 14 1 received preoperative chemother. oma has been defined by the seventh edition of AJCC apy Histologically 79 85 9 and 13 14 1 of 92. UICC TNM Cancer Staging Manual However it does patients had tumors mainly composed with adenocarcin. not cover all of the cancer near the EGJ for example a oma and squamous cell carcinoma Mean pathological. localized gastric adenocarcinoma with centered in the tumor size was 46 1 mm Two 16 and 11 tumors were. stomach within 5 cm from EGJ Thus we categorized categorized as Siewert types I II and III respectively. tumors near the EGJ into four types according to loca Siewert classification was not applicable to the. tion and main histological type Figure 1 Categorization remaining 63 tumors In 63 tumors which did not apply. criteria were i squamous cell carcinoma centered in to Siewert classification 50 and 13 tumors were mainly. the esophagus within 5 cm from EGJ type E SQ ii composed with adenocarcinoma and squamous cell car. adenocarcinoma centered in the esophagus within 5 cm cinoma However 15 and 48 tumors centered in the. from EGJ type E AD iii any histological tumor cen esophagus and the stomach only one tumor had esopha. tered in the stomach within 5 cm from EGJ with EGJ in gogastric junctional invasion Eighteen 19 6 27. vasion type Ge iv any histological tumor centered in 29 3 and 47 51 1 tumors were categorized type E. the stomach within 5 cm from EGJ without EGJ invasion G and Ge respectively The mean number of dissected. Ito et al Journal of Experimental Clinical Cancer Research 2013 32 2 Page 5 of 12. http www jeccr com content 32 1 2, Table 2 Comparison of clinicopathological characteristics.
Variable Type E SQ n 12 Type E AD n 6 Type Ge n 27 Type G n 47 P value. Male 10 5 20 37, Female 2 1 7 10, Age mean SD 64 4 6 84 66 3 7 97 65 2 10 6 66 5 9 67 0 728. Extent of surgical resection 0 001, Subtotal esophagectomy with partial gastrectomy 11 3 0 0. Proximal gastrectomy with partial esophagectomy 1 1 8 20. Total gastrectomy with partial esophagectomy 0 2 19 27. Extent of lymph node dissection 0 001, Abdominal mediastinal and cervical 9 2 0 0. Abdominal and mediastinal 2 3 4 0, Abdominal and lower mediastinal 1 1 17 8. Abdominal 0 0 6 39, Number of dissected lymph nodes mean SD 28 1 12 1 28 7 18 1 46 4 34 6 35 3 26 8 0 295.
Pathological tumor size mm mean SD 46 3 22 4 41 5 36 4 62 2 18 6 37 9 20 5 0 001. Main histological type 0 001, Squamous cell carcinoma 12 0 1 0. Adenocarcinoma 0 6 26 47, Esophagogastric junctional invasion 0 001. Yes 6 3 27 0, No 6 3 0 47, Siewert classification 0 001. Type I 2 0 0 0, Type II 1 0 15 0, Type III 0 0 11 0. Not applicable 3 12 1 47, Depth of tumor invasion 0 025.
pT1 3 3 4 23, pT2 0 1 3 7, pT3 9 2 14 10, pT4 0 0 6 7. Lymph node metastasis 0 005, pN0 3 3 8 33, pN1 6 2 6 5. pN2 2 1 5 6, pN3 1 0 8 3, Distant metastasis 0 001. M0 8 5 12 47, M1 4 1 15 0, TNM Stage 0 001, pStage I 2 3 4 27. pStage II 2 0 6 11, pStage III 4 2 2 9, pStage IV 4 1 15 0.
P 0 05 P 0 01, Including lower thoracic paraesophageal diaphragmatic and posterior mediastinal lymph node. Ito et al Journal of Experimental Clinical Cancer Research 2013 32 2 Page 6 of 12. http www jeccr com content 32 1 2, Table 3 Number of patients with positive nodes. Variable Type E SQ n 12 Type E AD n 6 Type Ge n 27 Type G n 47 P value. Overall 7 12 58 3 3 6 50 0 19 27 70 4 14 47 29 8 0 003. Depth of tumor invasion, pT1 2 3 66 7 0 3 2 4 50 0 0 23 0 001. pT2 1 1 100 2 3 66 7 3 7 42 9 0 497, pT3 5 9 55 6 2 2 100 0 9 14 64 3 6 10 60 0 0 697. pT4 6 6 100 5 7 71 4 0 269, Main histological type.
Squamous cell carcinoma 7 12 66 7 0 1 0 462, Adenocarcinoma 3 6 50 0 19 26 73 1 14 47 29 8 0 002. Location of lymph node, Cervical LN 2 9 22 2 0 2 0 655. Upper middle mediastinal 0 11 0 5 0 4, Lower mediastinal 2 12 16 7 2 6 33 3 2 20 10 0 0 8 0 298. Perigastric LN 6 12 50 0 3 6 50 0 17 27 63 0 13 47 27 7 0 026. Left paracardial 1 2 8 2, Right paracardial 3 3 10 5. Lesser curvature 4 1 13 10, Greater curvature 0 1 4 1.
Suprapyloric 0 0 0 0, Infrapyloric 0 0 1 0, LN along left gastric artery 2 12 16 7 1 6 16 7 5 27 18 5 7 47 14 9 0 983. LN at Celiac trunk 0 6 0 3 1 19 5 3 2 24 8 3 0 837. LN along hepatic artery 0 3 0 1 3 19 15 8 1 27 3 7 0 459. LN along splenic artery 0 2 1 3 33 3 2 22 9 1 1 23 4 3 0 356. LN at splenic hilum 3 17 17 6 0 9 0 262, P 0 05 P 0 01. Number of the patients with nodal metastasis number of the patients underwet lymph node dissection. Lower thoracic paraesophageal diaphragmatic and posterior mediastinal lymph node. LN Lymph node, lymph nodes was 37 2 28 0 SD in each patient Forty Ge tumors and 14 29 8 of 47 type G tumors had. five 48 9 of 92 patients had lymph node metastases lymph nodes metastases P 0 003 Although incidence. pN1 3 Thirty six 39 1 19 20 7 17 18 5 and of nodal metastasis in pT1 tumor was significantly lower. 20 21 7 patients were pathologically staged I II III in the type G tumor group than the other type tumor. and IV respectively Forty nine patients 53 3 had pre groups there was no significant difference in pT2 pT3. operative chemotherapy and pT4 tumors among 4 tumor groups With regard to. Comparison of clinicopathological characteristics among lymph node location no nodal metastasis in the cervical. type E SQ E AD Ge and G tumor group are summar and mediastinal lymph nodes was seen in the type G. ized in Table 2 There were significant differences in extent tumor group Although nodal metastases in perigastric. of surgical resection pathological tumor size main histo lymph nodes were seen in all tumor types only one nodal. logical type depth of tumor invasion pT category lymph metastasis in intra abdominal lymph nodes except for. node metastasis pN category distant metastasis pM cat perigastric lymph nodes was recognized in type E tumor. egory and TNM tumor stage Histologically 26 96 3 of group Nodal metastasis at the splenic hilum was seen in. 27 type Ge tumor and all 47 type G tumors were adenocar only in the Ge tumor group As a result incidence rates. cinoma Patients with Type G tumors tended to have earl for nodal metastasis in cervical mediastinal and perigas. ier stage diseases than the other tumor groups tric lymph nodes differed among 4 patients groups. RESEARCH Open Access Clinicopathological characteristics and optimal management for esophagogastric junctional cancer a single center retrospective cohort study Hiroaki Ito Haruhiro Inoue Noriko Odaka Hitoshi Satodate Michitaka Suzuki Shumpei Mukai Yusuke Takehara Hiroyuki Kida and Shin ei Kudo Abstract Background Esophagogastric junctional EGJ cancer occurs in the mucosa near the

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