Modified Systemic Inflammation Score Is an Independent Predictor of Long-Term Outcome in Patients Undergoing Surgery for Adenocarcinoma of the Esophagogastric Junction

Background: The modified systemic inflammation score (mSIS), which is calculated by a composite score of the lymphocyte-to-monocyte ratio and the albumin content in serum, is identified as the new score to predict the prognosis for various cancers. However, its significance for patients with adenocarcinoma of esophagogastric junction (AEJ), who receive surgery, remains unclear.Methods: This study retrospectively analyzed 317 patients with AEJ receiving surgery between September 2010 and December 2016. The associations between the mSIS and the clinicopathological features, overall survival (OS), as well as relapse-free survival (RFS), were assessed. In addition, the time-dependent receiver operating characteristic (t-ROC) curve analysis was performed for comparing the value of those scoring systems in predicting patient prognosis.Results: Of the 317 cases, 119 were rated as mSIS 0, 123 as mSIS 1, and 75 as mSIS 2. Besides, mSIS was significantly related to age and tumor size. On multivariate analysis, mSIS was identified as a predictor to independently predict OS (p < 0.001) along with RFS (p < 0.001), and a significantly strong correlation was observed at the advanced pTNM stages based on the mSIS system. In the subgroup analysis of adjuvant chemotherapy and surgery alone, mSIS was still the predictor for independently predicting patient OS (p < 0.001) together with RFS (p < 0.001) for the two groups. T-ROC analysis showed that mSIS was more accurate than controlling nutritional status score in predicting OS and RFS.Conclusions: The mSIS can serve as an easy, useful scoring system to independently predict the preoperative survival for AEJ cases undergoing surgery.

Prognostic impact of advanced lung cancer inflammation index (ALI) on patients with adenocarcinoma of esophagogastric junction (AEG) after radical resection

Background To evaluate the prognostic impact of the advanced lung cancer index (ALI) in patients with the adenocarcinoma of esophagogastric junction (AEG) after radical resection. Methods The data of patients with AEG after radical resection at Guangdong Provincial People’s Hospital from January 2008 to December 2018 were retrieved. The cutoff value of ALI was determined and the prognostic impact of clinicopathological factors and ALI were analyzed. A nomogram based on the independent prognostic factors for overall survival was then built. Results A total of 147 patients were eligible and based on a cutoff of ALI 43.1, 90 (61.2%) and 57 (38.8%) patients were classified in a low- (ALI༜43.1) and high-ALI (ALI༞43.1) group. Multivariate Cox proportional hazard analysis showed that low-ALI was associated with poor overall survival (OS) (p༜0.001, HR 2.541, 95%CI 1.408-4.410) and disease-free survival (DFS) (p=0.021, HR 1.789, 95%CI 1.020-2.674). In subgroup analysis, low-ALI was independent predictor for OS (p=0.001, HR 2.628, 95%CI 1.467-4.707) in stage III/IVA AEG patients. A nomogram for OS estimation was constructed and the C-index was 0.699 (95%CI 0.636-0.762) and the calibration plots showed satisfactory consistency between actual observation and nomogram-predicted OS probabilities. Further, satisfactory predictive accuracy for 1-, 2-, and 3-year OS rates with an area under the curve of 0.736, 0.712 and 0.697, respectively, was observed. Conclusions ALI was an independent prognostic factor for AEG patients after radical resection, and demonstrated promising ability for risk stratification of AEG, especially in advanced-stage disease.

Survival Benefit of Neoadjuvant Chemotherapy for Locally Advanced Adenocarcinoma of Esophagogastric Junction

Background/Aim: Adenocarcinoma of the esophagogastric junction (AEG) is refractory even when curative resection is followed by adjuvant chemotherapy. This study evaluated the efficacy of neoadjuvant chemotherapy (NAC) using an oral fluoropyrimidine-platinum regimen for AEG. Patients and Methods: Out of 35 patients with locally advanced AEG who underwent curative resection, 21 who underwent surgery first and 14 who received NAC were retrospectively compared in terms of survival. Results: The NAC regimens comprised of S-1 or capecitabine plus oxaliplatin or cisplatin; trastuzumab was added to six borderline resectable cases. The downstaging rate was 50% and the pathological response rate including complete response (29%) was 50%. The three-year relapse-free survival in the NAC group was significantly superior than the surgery-first group (78% vs. 22%, p=0.011). The NAC group had a significantly longer median survival time than the surgery-first group (NR vs. 29 months, p=0.032). Conclusion: NAC using an oral fluoropyrimidine-platinum regimen may provide survival benefit in AEG.

Prognostic Impact of Pathological Adverse Features in Surgically Resected Adenocarcinoma of Esophagogastric Junction

Objective The prognostic value of lymphovascular invasion (LVI), perineural invasion (PNI), and poor differentiation (PD) has been widely studied in different solid tumors. However, it was still controversial in adenocarcinoma of esophagogastric junction (AEG). We investigated the prognostic impact of combining LVI, PNI and PD for predicting the survival in patients with AEG.Methods We retrospectively investigated the data of patients who performed surgical resection of AEG on Guangdong Provincial Hospital and Guangdong Provincial Hospital of Chinese Medicine from Jan. 2004 to Dec. 2018. According to the status of LVI, PNI and differentiation, pathological adverse features were divided into three groups: 0, 1 or 2 and 3 adverse features, their impact on prognosis was evaluated. Results Univariate analysis indicated pT, pN, LVI , PNI , PD and pathological adverse features were risk factors for both overall survival (OS) and disease-specific survival (DSS), and multivariate analysis indicated that pathological adverse feature was independent risk factor for both OS and DSS. In subgroup analyses, adverse features were independent risk factor for DSS of stage II AEG but not for stage I or III.Conclusions The pathological adverse features were independent prognostic factors for AEG patients and they can help for further risk stratification in stage II patients.