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. 2018 Apr 10;2(3):187-196.
doi: 10.1002/ags3.12069. eCollection 2018 May.

Clinical significance of esophageal invasion length for the prediction of mediastinal lymph node metastasis in Siewert type II adenocarcinoma: A retrospective single-institution study

Kazuo Koyanagi  1 , Fumihiko Kato  1 , Jun Kanamori  1 , Hiroyuki Daiko  1 , Soji Ozawa  2 , Yuji Tachimori  3
Affiliations

Clinical significance of esophageal invasion length for the prediction of mediastinal lymph node metastasis in Siewert type II adenocarcinoma: A retrospective single-institution study

Kazuo Koyanagi et al. Ann Gastroenterol Surg. .

Abstract

Aim: This study investigated whether esophageal invasion length (EIL) of a tumor from the esophagogastric junction could be a possible indicator of mediastinal lymph node metastasis and survival in patients with Siewert type II adenocarcinoma.

Methods: One hundred and sixty-eight patients with Siewert type II tumor who underwent surgery were enrolled. Metastatic stations and recurrent lymph node sites were classified into cervical, upper/middle/lower mediastinal, and abdominal zones. EIL was correlated with overall metastasis or recurrence in individual zones and with survival.

Results: Siewert type II patients with an EIL of more than 25 mm (>25 mm EIL group) had a higher incidence of overall metastasis or recurrence in the upper and middle mediastinal zones than those with an EIL of less than or equal to 25 mm (≤25 mm EIL group) (P = .001 and P < .001). Disease-free and overall survival in the >25 mm EIL group were significantly lower than those of the ≤25 mm EIL group (P < .001). None of the Siewert type II patients with metastasis or recurrence in the upper and middle mediastinal zones survived for more than 5 years. Only an EIL of more than 25 mm was a significant preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zones (odds ratio, 8.85; 95% CI, 2.31-33.3; P = .001).

Conclusion: A multimodal-therapeutic strategy should be investigated in Siewert type II patients once the tumor has invaded more than 25 mm to the esophageal wall.

Keywords: Siewert type II; adenocarcinoma; esophageal invasion length; esophagogastric junction; mediastinal lymph node metastasis.

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Figures

Figure 1
Figure 1
Receiver operating characteristic curves were generated for deciding the cut‐off value of esophageal invasion length (EIL) in Siewert type II tumors to predict the risk of mediastinal lymph node metastasis. Cut‐off value of EIL was determined as 25 mm with an area under the curve of 0.83 (sensitivity, 80.8%; specificity, 72.3%)
Figure 2
Figure 2
Kaplan ‐Meyer curves according to esophageal invasion length (EIL) in Siewert type II tumors. A, disease‐free survival of the >25 mm EIL group was significantly lower than that of the ≤25 mm EIL group (P < .001). B, Overall survival of the >25 mm EIL group was significantly lower than that of the ≤25 mm EIL group (P < .001)
Figure 3
Figure 3
Overall survival of Siewert type II patients with overall metastasis or recurrence in each lymph node zone was significantly lower than that of Siewert type II patients without overall metastasis or recurrence. A, Upper mediastinal zone; P < .001. B, Middle mediastinal zone; P < .001. C, Lower mediastinal zone; P = .013. D, Abdominal zone; P < .001
See this image and copyright information in PMC

References

    1. Kusano C, Gotoda T, Khor JC, et al. Changing trends in the proportion of adenocarcinoma of esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol. 2008;23:1662–5. - PubMed
    1. Brown LMC, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst. 2008;100:1184–7. - PMC - PubMed
    1. Yamashita H, Seto Y, Sano T, et al. Results of a nation‐wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer. 2017;20:S69–83. - PubMed
    1. Siewert JR, Stein HJ. Classification of adenocarcinoma of the esophagogastric junction. Br J Surg. 1998;85:1457–9. - PubMed
    1. Brierley JD, Gospodarowicz MK, Wittekind C. Union for International Cancer Control (UICC). TNM classification of malignant tumors, 8th ed New York: Wiley; 2017.

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