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. 2023 Mar 8;15(6):1656.
doi: 10.3390/cancers15061656.

Prognostic Significance of Esophagogastric Junction Invasion in Patients with Adenocarcinoma of the Cardia or Subcardia

Sung Eun Oh  1 , Sujin Park  2 , Soomin Ahn  2 , Ji Yeong An  1 , Jun Ho Lee  1 , Tae Sung Sohn  1 , Jae Moon Bae  1 , Min-Gew Choi  1
Affiliations

Prognostic Significance of Esophagogastric Junction Invasion in Patients with Adenocarcinoma of the Cardia or Subcardia

Sung Eun Oh et al. Cancers (Basel). .

Abstract

Background: There has been no comparison of the prognoses of Korean patients who underwent curative surgery for cancer located at the cardia or subcardia of the stomach. We performed this comparison and further investigated the prognostic significance of esophagogastric junction (EGJ) invasion in patients.

Methods: The medical records of patients (n = 511) who were diagnosed with cardia or subcardia cancer and underwent surgery between January 2010 and May 2019 were retrospectively reviewed. Patients were further categorized into four groups for analysis: subcardia gastric cancer (sGC; subcardia cancer without EGJ invasion; n = 97), AEG (adenocarcinoma of the esophagogastric junction) type III (subcardia cancer with EGJ invasion, n = 54), AEG type II without EGJ invasion (n = 158), and AEG type II with EGJ invasion (n = 202). We compared the overall survival of the four groups using a gastric cancer staging system and evaluated the prognostic significance of EGJ invasion with multivariate analysis.

Results: The median follow-up of patients was 46.0 months (range: 0-124 months). There was significant difference in overall survival curves among the four groups (p < 0.001). Subgroup analysis showed a significant difference in overall survival between the groups with and without EGJ invasion (p < 0.001). Cancers with EGJ invasion were more frequently in the cardia (p < 0.001), had a larger size (p < 0.001), and showed a more advanced pathologic stage (stages II and III; 67.6% versus 33.7%, p < 0.001) than those without EGJ invasion. EGJ invasion and the pathologic stage were significant independent prognostic factors of overall survival in cardia and subcardia cancer patients (hazard ratio 2.24, 95% confidence interval 1.32-3.81, p = 0.003).

Conclusion: The overall survival between patients with cardia or subcardia cancer was significantly different according to EGJ invasion. EGJ invasion was an independent prognostic factor and should be considered for staging. Additional research is needed to apply this feature to gastric and esophageal cancer classification.

Keywords: Siewert classification; TNM staging system; cardia and subcardia cancer; esophagogastric junction; overall survival; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Adenocarcinomas of the cardia and the subcardia. Cardia and subcardia cancers were classified into four categories according to the location of the epicenter (red dots) and invasion of the esophagogastric junction (EGJ). (A) When the epicenter is located at the subcardia, the tumor is defined as either subcardia gastric cancer (without EGJ invasion) (a) or AEG (adenocarcinoma of the esophagogastric junction) type III (with EGJ invasion) (b). (B) When the epicenter is located at the cardia, the tumor is defined as AEG type II without EGJ invasion (c) or with EGJ invasion (d). AEG: adenocarcinoma of the esophagogastric junction; EGJ: esophagogastric junction.
Figure 2
Figure 2
(A) Overall survival of cardia or subcardia cancer patients. (B) Overall survival of cardia or subcardia cancer patients categorized by EGJ invasion. EGJ: esophagogastric junction; sGC: subcardia gastric cancer without esophagogastric junction invasion.
See this image and copyright information in PMC

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