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Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

AIM: To determine the optimal treatment strategy for Siewert type II and III adenocarcinoma of the esophagogastric junction. METHODS: We retrospectively reviewed the medical records of 83 patients with Siewert type II and III adenocarcinoma of the esophagogastric junction and calculated both an inde...

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Autores principales: Hosoda, Kei, Yamashita, Keishi, Moriya, Hiromitsu, Mieno, Hiroaki, Watanabe, Masahiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403751/
https://www.ncbi.nlm.nih.gov/pubmed/28487609
http://dx.doi.org/10.3748/wjg.v23.i15.2723
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author Hosoda, Kei
Yamashita, Keishi
Moriya, Hiromitsu
Mieno, Hiroaki
Watanabe, Masahiko
author_facet Hosoda, Kei
Yamashita, Keishi
Moriya, Hiromitsu
Mieno, Hiroaki
Watanabe, Masahiko
author_sort Hosoda, Kei
collection PubMed
description AIM: To determine the optimal treatment strategy for Siewert type II and III adenocarcinoma of the esophagogastric junction. METHODS: We retrospectively reviewed the medical records of 83 patients with Siewert type II and III adenocarcinoma of the esophagogastric junction and calculated both an index of estimated benefit from lymph node dissection for each lymph node (LN) station and a lymph node ratio (LNR: ratio of number of positive lymph nodes to the total number of dissected lymph nodes). We used Cox proportional hazard models to clarify independent poor prognostic factors. The median duration of observation was 73 mo. RESULTS: Indices of estimated benefit from LN dissection were as follows, in descending order: lymph nodes (LN) along the lesser curvature, 26.5; right paracardial LN, 22.8; left paracardial LN, 11.6; LN along the left gastric artery, 10.6. The 5-year overall survival (OS) rate was 58%. Cox regression analysis revealed that vigorous venous invasion (v2, v3) (HR = 5.99; 95%CI: 1.71-24.90) and LNR of > 0.16 (HR = 4.29, 95%CI: 1.79-10.89) were independent poor prognostic factors for OS. CONCLUSION: LN along the lesser curvature, right and left paracardial LN, and LN along the left gastric artery should be dissected in patients with Siewert type II or III adenocarcinoma of the esophagogastric junction. Patients with vigorous venous invasion and LNR of > 0.16 should be treated with aggressive adjuvant chemotherapy to improve survival outcomes.
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spelling pubmed-54037512017-05-09 Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up Hosoda, Kei Yamashita, Keishi Moriya, Hiromitsu Mieno, Hiroaki Watanabe, Masahiko World J Gastroenterol Retrospective Cohort Study AIM: To determine the optimal treatment strategy for Siewert type II and III adenocarcinoma of the esophagogastric junction. METHODS: We retrospectively reviewed the medical records of 83 patients with Siewert type II and III adenocarcinoma of the esophagogastric junction and calculated both an index of estimated benefit from lymph node dissection for each lymph node (LN) station and a lymph node ratio (LNR: ratio of number of positive lymph nodes to the total number of dissected lymph nodes). We used Cox proportional hazard models to clarify independent poor prognostic factors. The median duration of observation was 73 mo. RESULTS: Indices of estimated benefit from LN dissection were as follows, in descending order: lymph nodes (LN) along the lesser curvature, 26.5; right paracardial LN, 22.8; left paracardial LN, 11.6; LN along the left gastric artery, 10.6. The 5-year overall survival (OS) rate was 58%. Cox regression analysis revealed that vigorous venous invasion (v2, v3) (HR = 5.99; 95%CI: 1.71-24.90) and LNR of > 0.16 (HR = 4.29, 95%CI: 1.79-10.89) were independent poor prognostic factors for OS. CONCLUSION: LN along the lesser curvature, right and left paracardial LN, and LN along the left gastric artery should be dissected in patients with Siewert type II or III adenocarcinoma of the esophagogastric junction. Patients with vigorous venous invasion and LNR of > 0.16 should be treated with aggressive adjuvant chemotherapy to improve survival outcomes. Baishideng Publishing Group Inc 2017-04-21 2017-04-21 /pmc/articles/PMC5403751/ /pubmed/28487609 http://dx.doi.org/10.3748/wjg.v23.i15.2723 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Cohort Study
Hosoda, Kei
Yamashita, Keishi
Moriya, Hiromitsu
Mieno, Hiroaki
Watanabe, Masahiko
Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up
title Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up
title_full Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up
title_fullStr Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up
title_full_unstemmed Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up
title_short Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up
title_sort optimal treatment for siewert type ii and iii adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up
topic Retrospective Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403751/
https://www.ncbi.nlm.nih.gov/pubmed/28487609
http://dx.doi.org/10.3748/wjg.v23.i15.2723
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