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Comparative Study
. 2021 Jul;24(4):926-936.
doi: 10.1007/s10120-021-01169-6. Epub 2021 Mar 2.

Is advanced esophageal adenocarcinoma a distinct entity from intestinal subtype gastric cancer? Data from the AGAMENON-SEOM Registry

Felipe Alvarez-Manceñido  1 , Paula Jimenez-Fonseca  2 , Alberto Carmona-Bayonas  3 , Virginia Arrazubi  4 , Raquel Hernandez  5 , Juana M Cano  6 , Ana Custodio  7 , Carles Pericay Pijaume  8 , Gema Aguado  9 , Nieves Martínez Lago  10 , Manuel Sánchez Cánovas  11 , Diego Cacho Lavin  12 , Laura Visa  13 , Alba Martinez-Torron  14 , Aranzazu Arias-Martinez  15 , Flora López  16 , M Luisa Limón  17 , Rosario Vidal Tocino  18 , Ana Fernández Montes  19 , Maria Alsina  20 , Paola Pimentel  21 , Pablo Reguera  22 , Alfonso Martín Carnicero  23 , Avinash Ramchandani  24 , Mónica Granja  25 , Aitor Azkarate  26 , Marta Martín Richard  27 , Olbia Serra  28 , Carolina Hernández Pérez  29 , Alicia Hurtado  30 , Aitziber Gil-Negrete  31 , Tamara Sauri  32 , Patricia Morales Del Burgo  33 , Javier Gallego  34
Affiliations
Comparative Study

Is advanced esophageal adenocarcinoma a distinct entity from intestinal subtype gastric cancer? Data from the AGAMENON-SEOM Registry

Felipe Alvarez-Manceñido et al. Gastric Cancer. 2021 Jul.

Abstract

Background: Advanced esophageal adenocarcinoma (EAC) is generally treated similarly to advanced gastroesophageal junction (GEJ-AC) and gastric (GAC) adenocarcinomas, although GAC clinical trials rarely include EAC. This work sought to compare clinical characteristics and treatment outcomes of advanced EAC with those of GEJ-AC and GAC and examine prognostic factors.

Patients and methods: Participants comprised patients with advanced EAC, intestinal GEJ-AC, and GAC treated with platin and fluoropyrimidine (plus trastuzumab when HER2 status was positive). Overall and progression-free survival were estimated using the Kaplan-Meier method. Cox proportional hazards regression gauged the prognostic value of the AGAMENON model.

Results: Between 2008 and 2019, 971 participants from the AGAMENON-SEOM registry were recruited at 35 centers. The sample included 67.3% GAC, 13.3% GEJ-AC, and 19.4% EAC. Pulmonary metastases were most common in EAC and peritoneal metastases in GAC. Median PFS and OS were 7.7 (95% CI 7.3-8.0) and 13.9 months (12.9-14.7). There was no difference in PFS or OS between HER2- and HER2+ tumors from the three locations (p > 0.05). Five covariates were found to be prognostic for the entire sample: ECOG-PS, histological grade, number of metastatic sites, NLR, and HER2+ tumors treated with trastuzumab. In EAC, the same variables were prognostic except for grade. The favorable prognosis for HER2+ cancers treated with trastuzumab was homogenous for all three subgroups (p = 0.351) and, after adjusting for the remaining covariates, no evidence supported primary tumor localization as a prognostic factor (p = 0.331).

Conclusion: Our study supports the hypothesis that EAC exhibits clinicopathological characteristics, prognostic factors, and treatment outcomes comparable to intestinal GEJ-AC and GAC.

Keywords: Advanced cancer; Chemotherapy; Erbb; Esophageal adenocarcinoma; Gastric cancer; Gastroesophageal junction; Lauren type; Prognosis; Survival; Trastuzumab.

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