Abstract
Background
In Siewert type II adenocarcinoma we investigated the relationship between adenocarcinoma subtypes and survival, histologic/biologic patterns related to the presence/absence of gastric greater curvature metastases.
Methods
154 patients who underwent primary transthoracic esophageal resection, total gastrectomy, thoracic-abdominal lymphadenectomy according to a research prospective protocol were considered. Cases were categorized in intestinal and diffuse subtypes, in Barrett's-like, cardiopyloric-like, and gastric-like adenocarcinoma according to the presence/absence of intestinal metaplasia in esophagus and stomach. Cancer specific survival and gastric greater curvature metastases were studied in those categories.
Results
Pathological stage (7th TNM ed) was IA-IIA in 11%; IIB in 15.6%; IIIA-IV in 73.4%. Cases were: 59% intestinal-type, 41% diffuse-type; Barrett's-type 1.3%, cardiopyloric-type 65%, gastric-type 33.7%. Greater gastric curvature lymph node metastases were detected in 22%, in stage IIIa-IV only, intestinal type 47%; diffuse type 53%. The number of metastatic lymph nodes at station 4 was higher in cardiopyloric-like than in gastric-like type (P < .0001).Five years cancer-specific survival of 154 cases was 40.5%, 59.4.% for intestinal type, 0% for diffuse type; 5-year cancer-specific survival in the absence/presence of greater gastric curvature metastases was respectively 48.7% and 14.9%, for intestinal type it was 67.4% and 27.9%. Histological subtype was an independent prognostic factor.
Conclusion
The radical difference of 5 year survival between intestinal and diffuse types of Siewert type II adenocarcinoma after primary surgery, the relevant frequency and biologic patterns of station 4 nodal metastases do require further investigation in light of current indications for neoadjuvant therapy and total gastrectomy.
Disclosure
All authors have declared no conflicts of interest.
CDX1 and CDX2 Expression in Intestinal Metaplasia, Dysplasia and Gastric Cancer