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Comparative Study
. 2019 Dec 31:2019:9637972.
doi: 10.1155/2019/9637972. eCollection 2019.

Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

Kaixuan Zhu  1 , Yingying Xu  2 , Jiaxin Fu  1 , Farah Abdidahir Mohamud  1 , Zongkui Duan  1 , Siyuan Tan  1 , Zekun Zhao  3 , Ping Chen  1 , Liang Zong  1
Affiliations
Comparative Study

Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

Kaixuan Zhu et al. Dis Markers. .

Abstract

Background: To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data.

Methods: Patients with Siewert type II AEG treated by TG or PG were identified from the 2004-2014 SEER dataset. We obtained the patients' overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model.

Results: A total of 2,217 patients with 6th AJCC stage IA-IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1-131 months. OS favored total gastrectomy before the PSM analysis (χ 2 = 3.952, p = 0.047), but after this analysis, there was no significant difference between TG and PG (χ 2 = 2.227, p = 0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged ≥ 70 years obtained a significant long-term OS benefit from PG compared to TG (χ 2 = 8.245, p = 0.004), and those aged < 70 years showed no difference between TG and PG (χ 2 = 0.167, p = 0.682).

Conclusions: PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of tumor size in PG and TG groups. (a, b) Histogram of tumor sizes in the PG group and the TG group. (c) Independent sample Mann-Whitney U test shows the tumor sizes in the TG group were significantly larger than those in the PG group.
Figure 2
Figure 2
Survival comparisons in Siewert type II AEG patients between the PG group and the TG group. (a, b) OS (χ2 = 3.952, p = 0.047) and CSS (χ2 = 3.028, p = 0.073) before the PSM analysis. (c, d) OS (χ2 = 2.227, p = 0.136) and CSS (χ2 = 1.211, p = 0.271) after the PSM analysis.
Figure 3
Figure 3
OS comparisons between PG and TG before and after the PSM in the subgroup analysis.
Figure 4
Figure 4
OS analysis of the age subgroups. (a) Results of the X-tile analysis of OS data of 2,217 Siewert type II AEG patients with age as a factor. The optimal cut-off value for the patients' age is shown on a histogram and Kaplan-Meier curves. The X-tail analysis showed that 70 years was the optimal cut-off value. (b) Kaplan-Meier analysis of OS between the PG and TG patients in the subgroups of patients aged < 70 years (χ2 = 0.167, p = 0.682) and those aged ≥ 70 years (χ2 = 8.245, p = 0.004). (c) Kaplan-Meier analysis of CSS analysis between the PG and TG patients in the subgroups of patients aged < 70 years (χ2 = 1.686, p = 0.194) and those aged ≥ 70 years (χ2 = 3.895, p = 0.048).
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