Siewert Classification of Adenocarcinoma of the Esophagogastric Junction: Still In or Already Out?

We presented the X-ray and CT findings characteristic for gastric cancers of different localizations (localized in different parts of the stomach). Particularly, esophagogastric junction (EGJ) carcinomas and antral carcinomas are singled out, as two localizations of gastric cancer that we usually meet in everyday clinical and radiological practice, and which have completely different radiological presentation. Advanced carcinomas of esophago-gastric junction, whose incidence is on the rise, usually affect the distal segment of the esophagus, cardia, and proximal part of the stomach, in different proportions. Siewert's, and the Japanese classification of these tumors are listed. Due to the involvement of the distal esophagus, scanning region, besides the abdomen, should be expanded to the chest. Advanced cancer of the antral part of the stomach is presented by the X-ray as a fungating, infiltrative, or combined form, often capturing the entire wall circumference. Possible infiltration of the left liver, the body and neck of the pancreas, colon and anterior abdominal wall should be estimated by CT.

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Changing patterns in presentation and therapy of esophagogastric junction cancers in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.22 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 22-22

Author(s):

Roderich Schwarz ◽

David D. Smith ◽

Rebecca A. Nelson

Keyword(s):

Esophagogastric Junction ◽

The United States ◽

Tumor Location ◽

Tnm Staging ◽

Incidence Rates ◽

Preoperative Radiation ◽

Lower Stage ◽

Siewert Classification ◽

Changing Patterns ◽

The U.S

22 Background: Esophagogastric junction cancer (EGJC) has recently been included within the esophageal cancer (EC) AJCC TNM staging criteria. Trends in clinical presentation, therapeutic approach and outcomes are of interest. Methods: We identified EGJCs from the U.S. population SEER database and examined incidence, demographic, therapeutic and outcomes information. Siewert classification-related EGJC subtype-associated findings were also examined. Results: EGJC age-adjusted incidence rates (x10-5) have increased from 3.3 in 1973 to 7.5 in 2009. While the incidence rate for females has remained around 2, rates in males have increased from 6 to 13. Among 30,710 EGJC patients diagnosed between 1992 and 2009, potentially curative resection increased from 31% to 36% and radiation increased from 32% to 41% (p<0.0001). For resected EGJCs, significant trends over time include: increased total LN count (mean: 15.5 vs. 12.3), fewer positive LNs (3.1 vs. 4), smaller tumor size (29% vs. 36% >5 cm), lower T category (39% vs. 29% T1/2), lower N category (42% vs. 35% N0), lower stage group (29% vs. 38% stage 3/4), increased preoperative radiation (26% vs. 3%), decreased 90-day mortality (6.5 vs. 14.1%), longer overall survival (OS, median: 2.9 vs. 1.7 years) and longer disease-specific survival (median: 3.9 vs. 2.0 years) (all at p<0.0001). Multivariate predictors of OS include TNM categories, age, ethnicity, radiation, and total LN count (all at p<0.0001). There were significant differences in stage-for-stage OS between EC subtypes based on histology and primary tumor location, and in DSS between EGJC subtypes (Siewert I, II or III) as well. Conclusions: EGJC incidence rates, diagnosis and treatment have undergone significant changes within the U.S. population. The regional dissection extent remains an area of importance as it is associated with OS. Comparisons of various survival outcomes do not support using the same staging criteria for EGJC as for EC.

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Anatomical topography of the tumor is related to prognostic survival in adenocarcinoma of esophagogastric junction?: Multivariable analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.108 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 108-108

Author(s):

Flavio Roberto Takeda ◽

Rubens Antonio Aissar Sallum ◽

Ulysses Ribeiro ◽

Tiago Bianchi de Castria ◽

Francisco Tustumi ◽

...

Keyword(s):

Surgical Treatment ◽

Esophagogastric Junction ◽

Histological Grade ◽

Neoadjuvant Treatment ◽

Multivariable Analysis ◽

Epidemiological Data ◽

Adenocarcinoma Of Esophagogastric Junction ◽

Siewert Classification ◽

The Mean ◽

Pn Stage

108 Background: The adenocarcinoma of the esophagogastric junction (AJEG) is divided according to its anatomopathological classification (Siewert classification) for the choice of surgical treatment. However, both the Siewert classification and the location of the AJEG are related to different prognoses reported in the literature. Objectives: To compare the survival of patients with AJEG submitted to surgical treatment according to different topographies in the esophagogastric junction. Methods: 147 patients were selected between 2000 and 2016. One hundred and thirty (88%) males, mean age 64 years. Analyzing the retrieved lymph nodes, affected and the relation of resected and affected. AEGG (E: esophagus, E/TEG: gastric esophagus, TEG: gastric esophagus transition, TEG/G: esophageal gastric and stomach transition, and E/TEG/G: esophagus, transition and stomach) were analyzed for global survival, free of disease, and after relapse. Results: In relation to epidemiological data, the mean age was 63.1 years. Of the 147 patients 90 (61.2%) were submitted to neoadjuvant treatment. There was no statistical difference between the groups regarding histological grade, pT, pN, stage, tumor extension, lymphatic, venous and perineural invasion. The mean extension of the tumor was 5.4 cm. The mean number of retrieved lymphnodes were 32. Overall survival was E: 90%, E/TEG: 60%, TEG: 52%, TEG/G: 50% and E/TEG/G: 21%. (p <0.0001). Disease free of survival was E: 78%, E/TEG: 48%, TEG: 43%, TEG/G: 38% and E/TEG/G: 15%. (p <0.001). Conclusions: The survival of the AJEG varies according to the topography of the lesion, the tumors located closer to the stomach present worse survival than those located in the esophagus, except when the tumor is very extensive, from the esophagus to the stomach.

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