scholarly journals Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

2020 ◽  
Author(s):  
Weilin Zhang ◽  
Yong Li
Keyword(s):  
Lymph Node ◽  
Esophagogastric Junction ◽  
Curative Resection ◽  
Staging System ◽  
The Other ◽  
Type Ii ◽  
Siewert Type ◽  
Prognostic Performance ◽  
Siewert Type Ii ◽  
Staging Systems

Abstract Background: The tumor-node-metastasis (TNM) pN stage, which is based on the number of positive lymph nodes (LNs), is an important prognostic factor for patients with adenocarcinoma of the esophagogastric junction (AEG). The lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) staging systems are new effective indicators of prognosis. We aimed to evaluate their prognostic value in Siewert type II AEG.Methods: Patients diagnosed with Siewert type II AEG who underwent curative resection between 2004 and 2014 at Guangdong General Hospital were recruited. A Cox regression model was constructed, and prognostic performance was measured using Harrell’s concordance index (C-index) and the Akaike information criterion (AIC).Results: When LN status was modeled as a continuous variable, the LODDS system (C-index: 0.729; AIC: 940.483) outperformed the other staging systems, including the number of positive LNs (LNP) (C-index: 0.721; AIC: 946.935) and LNR (C-index: 0.725; AIC: 938.918).However,when assessed as categorical variables, the LNR staging system had a better prognostic performance (C-index: 0.752; AIC: 926.350) than the American Joint Committee on Cancer (AJCC) 8th edition TNM pN (C-index: 0.740; AIC: 934.349) and LODDS (C-index: 0.737; AIC: 939.087) staging systems. Each LNR stage is more evenly distributed than the other two staging systems. Moreover, the LODDS stage is more dependent on the TLNE.Conclusion: The LNR represented the best prognostic factor when assessed as a categorical variable and may serve as an alternative nodal staging system for AEG.

scholarly journals Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option

2018 ◽  
Vol 47 (1) ◽  
pp. 398-410 ◽  
Author(s):  
Can Hu ◽  
Hao-te Zhu ◽  
Zhi-yuan Xu ◽  
Jian-fa Yu ◽  
Yi-an Du ◽  
...  
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Abdominal Cavity ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii

Objective The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. In this study, we evaluated the outcomes of total gastrectomy for Siewert type II/III AEG via the left thoracic surgical approach that is used at our center. Methods We identified 41 patients with advanced AEG in our retrospective database and analyzed their 3-year survival rate, upper surgical margin, postoperative complications, and index of estimated benefit from lymph node dissection. Results The 3-year overall survival rate of the whole group was 63%, but no difference was observed between Siewert type II and III AEGs. Esophageal exposure and lymphadenectomy were sufficient. Eight patients developed postoperative complications, but none of the patients developed anastomotic leakage. Dissection of lymph node station Nos. 19 and 110 may be necessary for patients with Siewert type II AEG. Multivariate analysis revealed that the cT category was the only independent risk factor. Conclusions Total gastrectomy via an approach from the abdominal cavity into the thoracic cavity may be an optimal surgical technique for advanced Siewert type II AEG.

Priority of Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction

2013 ◽  
Vol 20 (13) ◽  
pp. 4252-4259 ◽  
Author(s):  
Shinichi Hasegawa ◽  
Takaki Yoshikawa ◽  
Yasushi Rino ◽  
Takashi Oshima ◽  
Toru Aoyama ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Esophagogastric Junction ◽  
Type Ii ◽  
Node Dissection ◽  
Siewert Type ◽  
Siewert Type Ii

scholarly journals Lymph node ratio is an independent prognostic factor for patients with Siewert type II adenocarcinoma of esophagogastric junction: results from a 10-year follow-up study

2020 ◽  
Author(s):  
Yuling Zhang ◽  
Ditian Liu ◽  
Chunfa Chen ◽  
De Zeng
Keyword(s):  
Regression Analysis ◽  
Lymph Node ◽  
Esophagogastric Junction ◽  
Lymph Node Ratio ◽  
Cox Regression ◽  
Type Ii ◽  
Siewert Type ◽  
Cox Regression Analysis ◽  
Siewert Type Ii ◽  
Node Ratio

Abstract Background Emerging evidences suggest that lymph node ratio (LNR), the number of metastatic lymph node (LN) to the total number of dissected lymph nodes (NDLN), may predict survival in multiple types of solid tumor. However, the prognostic role of LNR in adenocarcinoma of the esophagogastric junction (AEG) remains uninvestigated. The study is intended to determine the prognostic value of LNR in the patients with Siewert type II AEG. Methods A total of 342 patients with Siewert type II AEG who underwent R0 resection were enrolled in this study. The optimal cut-off of LNR was stratified into tertiles using X-tile software. The log-rank test was used to evaluate the survival differences, and multivariate Cox regression analysis were performed to determine the independent prognostic variables. Results The optimal cut-off of LNR were classified as LNR = 0, LNR between 0.01 and 0.40 and LNR > 0.41. Patients with high LNR had a shorter 5- and 10-year disease-specific survival (DSS) rate (8.5%, 1.4%) compared with those with moderate LNR (20.4%, 4.9%) and low LNR (58.0%, 27.5%) ( P < 0.001). Multivariate Cox regression analysis indicated that LNR was an independent factor for DSS after adjusting for confounding variables ( P < 0.05). Furthermore, after stratification by NDLN between NDLN < 15 group and NDLN ≥ 15 group, the LNR remained a significant predictor for DSS ( P < 0.05). Conclusions LNR is an independent predictor for DSS in patients with Siewert type II AEG regardless of NDLN. Patients with higher LNR have significantly shorter DSS.

scholarly journals Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Xia Lin ◽  
Zhengyan Li ◽  
Chenjun Tan ◽  
Xiaoshuang Ye ◽  
Jie Xiong ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Esophagogastric Junction ◽  
Tumor Diameter ◽  
Type Ii ◽  
Node Dissection ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Type Iii ◽  
Siewert Type Iii

BackgroundIt is unclear whether the dissection of pyloric lymph nodes (PLNs, No. 5 and No. 6 lymph nodes) is necessary for adenocarcinoma of the esophagogastric junction (AEG) with a tumor diameter &gt;4 cm based on current guidelines. This study aimed at evaluating whether pyloric node lymphadenectomy is essential for patients with Siewert type II/III AEG according to different tumor diameters.MethodsThis study included 300 patients on whom transabdominal total gastrectomy was performed for Siewert type II/III AEG at a high-volume center in China from January 2006 to December 2015. The index of estimated benefit from lymph node dissection (IEBLD) was used to analyze the priority of pyloric lymphadenectomy.ResultsIn Siewert type II AEG, the 5-year overall survival (OS) and the 5-year disease-free survival (DFS) were similar between patients with PLN-positive cancer and patients of stage III AEG without PLN metastasis (23.1% vs. 30.6%, p = 0.505; 23.1% vs. 27.1%, p = 0.678). However, in Siewert type III AEG, the OS and the DFS of patients with PLN-positive cancer were significantly lower than that of patients with stage III without PLN metastasis (7.9% vs. 27.8%, p = 0.021; 0 vs. 26.8%, p = 0.005). According to the IEBLD, the dissection of PLNs did not appear to be beneficial in either Siewert type II AEG or type III AEG, whereas a stratified analysis revealed that PLN dissection yielded a high therapeutic benefit for Siewert type II AEG with tumor diameters &gt;4 cm.ConclusionWe recommended that the PLNs be dissected in Siewert type II AEG when a tumor diameter is &gt;4 cm. Total gastrectomy should be optional for Siewert type II AEG with a tumor diameter &gt;4 cm and Siewert type III AEG.

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