Analysis of related factors for postoperative recurrence and metastasis of type <b>Ⅱ</b> and <b>Ⅲ</b> adenocarcinoma of esophagogastric junction _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIA Wenhao , ZHANG Yingji , YANG Yifan , YUAN Aihua , CHEN Wei ,  LÜ Chengyu

Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, P. R. China;

Corresponding author：

LÜ Chengyu, Email: lcy_1234@aliyun.com

Keywords：

adenocarcinoma of esophagogastric junction; type of Siewert Ⅱ/Ⅲ; recurrence and metastasis; influencing factor

DOI：

10.7507/1007-9424.201801015

Video：

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Objective To explore the risk factors of recurrence and metastasis in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical gastrectomy. Methods A retrospective study was conducted to collect the clinical data of 146 patients with type Ⅱ and Ⅲ AEG who underwent radical gastrectomy from January 2010 to January 2013 in the Nanjing First Hospital of Nanjing Medical University. The factors affected the recurrence and metastasis of the patients after the radical gastrectomy were analyzed by the unconditional logistic regression analysis. Results The 146 AEG patients were followed up for 3–84 months, with the median follow-up time of 48 months. During the follow-up period, there were 59 cases suffered from recurrence and metastasis. The recurrence and metastasis time was 1–50 months after radical gastrectomy, with the median time of 17 months after radical gastrectomy. The results of multivariate logistic regression analysis showed that, the histological grade (OR=4.478, P=0.015), the number of positive lymph nodes (OR=2.886, P<0.001), and vascular invasion (OR=5.334, P=0.003) were independent risk factors for the recurrence and metastasis of AEG patients after radical gastrectomy. Patients with low tumor histological grade (G3+G4), a large number of positive lymph nodes, and vascular invasion were more likely to have recurrence and metastasis after radical gastrectomy. Conclusions The histological grade of tissue, number of positive lymph nodes, and vascular invasion are important factors in predicting the recurrence and metastasis of Siewert Ⅱ/Ⅲ AEG patients after radical gastrectomy.

Citation： XIA Wenhao, ZHANG Yingji, YANG Yifan, YUAN Aihua, CHEN Wei, LÜ Chengyu. Analysis of related factors for postoperative recurrence and metastasis of type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(8): 947-953. doi: 10.7507/1007-9424.201801015 Copy

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2.	Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA Oncol, 2015, 1(4): 505-527.
3.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
4.	Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol, 2013, 23(1): 3-9.
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6.	Maeda H, Okabayashi T, Nishimori I, et al. Clinicopathologic features of adenocarcinoma at the gastric cardia: is it different from distal cancer of the stomach? J Am Coll Surg, 2008, 206(2): 306-310.
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8.	Lagarde SM, Reitsma JB, Ten Kate FJ, et al. Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction. Ann Surg, 2008, 248(6): 1006-1013.
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12.	Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol, 2017, 12(1): 36-42.
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14.	郭春光, 田艳涛. 食管胃结合部腺癌的外科治疗与争议. 中国医学前沿杂志(电子版), 2017, 9(5): 1-5.
15.	Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
16.	Hosoda K, Yamashita K, Moriya H, et al. Optimal treatment for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up. World J Gastroenterol, 2017, 23(15): 2723-2730.
17.	张洪典, 唐鹏, 陈传贵, 等. 进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素分析. 中华消化外科杂志, 2013, 12(10): 783-787.
18.	Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable esophageal cancer. J Gastrointest Surg, 2007, 11(11): 1384-1393.
19.	Li P, Ling YH, Zhu CM, et al. Vascular invasion as an independent predictor of poor prognosis in nonmetastatic gastric cancer after curative resection. Int J Clin Exp Pathol, 2015, 8(4): 3910-3918.
20.	Parnaby CN, Scott NW, Ramsay G, et al. Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection. Br J Cancer, 2015, 113(2): 212-219.
21.	Lee JH, Kim MG, Jung MS, et al. Prognostic significance of lymphovascular invasion in node-negative gastric cancer. World J Surg, 2015, 39(3): 732-739.
22.	Li ZG, Zhu H, Shi H, et al. Lymphovascular invasion and nodal metastasis in intramucosal adenocarcinoma of the esophagus and esophagogastric junction. J Dig Dis, 2015, 16(4): 197-204.
23.	Nordenstedt H, El-Serag H. The influence of age, sex, and race on the incidence of esophageal cancer in the United States (1992-2006). Scand J Gastroenterol, 2011, 46(5): 597-602.
24.	Bodelon C, Anderson GL, Rossing MA, et al. Hormonal factors and risks of esophageal squamous cell carcinoma and adenocarcinoma in postmenopausal women. Cancer Prev Res (Phila), 2011, 4(6): 840-850.
25.	Rutegård M, Nordenstedt H, Lu Y, et al. Sex-specific exposure prevalence of established risk factors for oesophageal adenocarcinoma. Br J Cancer, 2010, 103(5): 735-740.
26.	Löfdahl HE, Lu Y, Lagergren J. Sex-specific risk factor profile in oesophageal adenocarcinoma. Br J Cancer, 2008, 99(9): 1506-1510.
27.	刘尚国, 齐博, 赵宝生, 等. 食管癌根治术后早期复发转移的影响因素. 中国老年学杂志, 2016, 36(16): 3992-3994.
28.	Forget P, Dinant V, De Kock M. Is the neutrophil-to-lymphocyte ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery? Peer J, 2015, 3: e713.
29.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA Oncol, 2015, 1(4): 505-527.
3. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
4. Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol, 2013, 23(1): 3-9.
5. Cook MB, Kamangar F, Whiteman DC, et al. Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst, 2010, 102(17): 1344-1353.
6. Maeda H, Okabayashi T, Nishimori I, et al. Clinicopathologic features of adenocarcinoma at the gastric cardia: is it different from distal cancer of the stomach? J Am Coll Surg, 2008, 206(2): 306-310.
7. Liu K, Zhang W, Chen X, et al. Comparison on clinicopathological features and prognosis between esophagogastric junctional adenocarcinoma (Siewert Ⅱ/Ⅲ types) and distal gastric adenocarcinoma: retrospective cohort study, a single institution, high volume experience in China. Medicine (Baltimore), 2015, 94(34): e1386.
8. Lagarde SM, Reitsma JB, Ten Kate FJ, et al. Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction. Ann Surg, 2008, 248(6): 1006-1013.
9. 黄永高, 王鹏程, 王嵩, 等. Ⅰ、Ⅱ型食管胃连接处腺癌根治性切除术后早期复发的相关因素分析. 中国癌症杂志, 2016, 26(5): 458-461.
10. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3^rd English edition. Gastric Cancer, 2011, 14(2): 101-112.
11. Rüdiger Siewert J, Feith M, Werner M, et al. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
12. Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol, 2017, 12(1): 36-42.
13. Pedrazzani C, de Manzoni G, Marrelli D, et al. Lymph node involvement in advanced gastroesophageal junction adenocarcinoma. J Thorac Cardiovasc Surg, 2007, 134(2): 378-385.
14. 郭春光, 田艳涛. 食管胃结合部腺癌的外科治疗与争议. 中国医学前沿杂志(电子版), 2017, 9(5): 1-5.
15. Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
16. Hosoda K, Yamashita K, Moriya H, et al. Optimal treatment for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up. World J Gastroenterol, 2017, 23(15): 2723-2730.
17. 张洪典, 唐鹏, 陈传贵, 等. 进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素分析. 中华消化外科杂志, 2013, 12(10): 783-787.
18. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable esophageal cancer. J Gastrointest Surg, 2007, 11(11): 1384-1393.
19. Li P, Ling YH, Zhu CM, et al. Vascular invasion as an independent predictor of poor prognosis in nonmetastatic gastric cancer after curative resection. Int J Clin Exp Pathol, 2015, 8(4): 3910-3918.
20. Parnaby CN, Scott NW, Ramsay G, et al. Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection. Br J Cancer, 2015, 113(2): 212-219.
21. Lee JH, Kim MG, Jung MS, et al. Prognostic significance of lymphovascular invasion in node-negative gastric cancer. World J Surg, 2015, 39(3): 732-739.
22. Li ZG, Zhu H, Shi H, et al. Lymphovascular invasion and nodal metastasis in intramucosal adenocarcinoma of the esophagus and esophagogastric junction. J Dig Dis, 2015, 16(4): 197-204.
23. Nordenstedt H, El-Serag H. The influence of age, sex, and race on the incidence of esophageal cancer in the United States (1992-2006). Scand J Gastroenterol, 2011, 46(5): 597-602.
24. Bodelon C, Anderson GL, Rossing MA, et al. Hormonal factors and risks of esophageal squamous cell carcinoma and adenocarcinoma in postmenopausal women. Cancer Prev Res (Phila), 2011, 4(6): 840-850.
25. Rutegård M, Nordenstedt H, Lu Y, et al. Sex-specific exposure prevalence of established risk factors for oesophageal adenocarcinoma. Br J Cancer, 2010, 103(5): 735-740.
26. Löfdahl HE, Lu Y, Lagergren J. Sex-specific risk factor profile in oesophageal adenocarcinoma. Br J Cancer, 2008, 99(9): 1506-1510.
27. 刘尚国, 齐博, 赵宝生, 等. 食管癌根治术后早期复发转移的影响因素. 中国老年学杂志, 2016, 36(16): 3992-3994.
28. Forget P, Dinant V, De Kock M. Is the neutrophil-to-lymphocyte ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery? Peer J, 2015, 3: e713.
29. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of related factors for postoperative recurrence and metastasis of type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction

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