Assessment of risk factors of lymph node metastasis and prognosis of Siewert II/III adenocarcinoma of esophagogastric junction: A retrospective study

Abstract

Adenocarcinoma of the esophagogastric junction (AEG) has a high incidence, and the extent of lymph node dissection (LND) and its impact on prognosis remain controversial. This study aimed to explore the risk factors for lymph node metastasis (LNM) and prognosis in Siewert II/III AEG patients. A retrospective review of 239 Siewert II/III AEG patients surgically treated at Beijing Friendship Hospital from July 2013 to December 2022 was conducted. Preoperative staging was conducted via endoscopy, ultrasound gastroscopy, CT, and biopsy. Depending on the stage, patients received radical gastrectomy with LND and chemotherapy. Clinicopathological data were collected, and survival was monitored semiannually until November 2023. Utilizing logistic regression for data analysis and Cox regression for survival studies, multivariate analysis identified infiltration depth (OR = 0.038, 95% CI: 0.011-0.139, P < .001), tumor deposit (OR = 0.101, 95% CI: 0.011-0.904, P = .040), and intravascular cancer embolus (OR = 0.234, 95% CI: 0.108-0.507, P < .001) as independent predictors of LNM. Lymph nodes No. 1, 2, 3, 4, 7, 10, and 11 were more prone to metastasis in the abdominal cavity. Notably, Siewert III AEG patients showed a higher metastatic rate in nodes No. 5 and No. 6 compared to Siewert II. Mediastinal LNM was predominantly found in nodes No. 110 and No. 111 for Siewert II AEG, with rates of 5.45% and 3.64%, respectively. A 3-year survival analysis underscored LNM as a significant prognostic factor (P = .001). Siewert II AEG patients should undergo removal of both celiac and mediastinal lymph nodes, specifically nodes No. 1, 2, 3, 4, 7, 10, 11, 110, and 111. Dissection of nodes No. 5 and No. 6 is not indicated for these patients. In contrast, Siewert III AEG patients do not require mediastinal LND, but pyloric lymphadenectomy for nodes No. 5 and No. 6 is essential. The presence of LNM is associated with poorer long-term prognosis. Perioperative chemotherapy may offer a survival advantage for AEG patients.

Figure 1.

The locations of lymph nodes in each group. No.1 - Right cardial lymph nodes; No.2 - Left cardial lymph nodes; No.3 - Lesser curvature lymph nodes; No.4sa - Short gastric artery lymph nodes; No.4sb - Left gastroepiploic artery lymph nodes; No.4d - Right gastroepiploic artery lymph nodes; No.5 - Suprapyloric lymph nodes; No.6 - Infrapyloric lymph nodes; No.7 - Left gastric artery lymph nodes; No.8a - Anterior hepatic artery lymph nodes; No.8p - Posterior hepatic artery lymph nodes; No.9 - Para-aortic lymph nodes; No.10 - Splenic hilum lymph nodes; No.11p - Proximal splenic artery lymph nodes; No.11d - Distal splenic artery lymph nodes; No.12a - Lymph nodes along the hepatic artery within the hepatoduodenal ligament; No.12b - Lymph nodes along the bile duct within the hepatoduodenal ligament; No.12p - Lymph nodes posterior to the portal vein within the hepatoduodenal ligament; No.19 - Subdiaphragmatic lymph nodes; No.20 - Diaphragmatic hiatus lymph nodes; No.110 - Lower mediastinal lymph nodes; No.111 - Supradiaphragmatic lymph nodes; No.112 - Posterior mediastinal lymph nodes.

Figure 2.

The 3-yr OS rate of AEG patients without LNM and with LNM was 88.0% and 64.5%, respectively (P = .001). AEG = adenocarcinoma of esophagogastric junction, LNM = lymph node metastasis, OS = overall survival.

Figure 3.

The 3-yr OS rate of AEG patients who accepted chemotherapy was higher than those who did not accept chemotherapy (P = .909). AEG = adenocarcinoma of esophagogastric junction.