The identification of reliable predictors of chemotherapy sensitivity and early screening of adenocarcinoma of gastroesophageal junction (AGEJ) patients who are resistant to chemotherapy has become an important area of clinical and translational research. We aimed to investigate the predictive value of seven cancer-associated cellular proteins for neoadjuvant chemotherapy in AGEJ patients. Clinical data of 93 patients who received neoadjuvant chemotherapy for locally advanced AGEJ between June 2010 and December 2014 were reviewed. All patients were administered the combination regimen of S-1 and oxaliplatin (SOX). Expression of P-glycoprotein (P-gp), glutathione S-transferase-π (GST-π), topoisomerase II (topo II), multidrug resistance gene-associated protein (MRP), lung resistance-related protein (LRP), Ki-67, and p53 was determined by immunohistochemistry (IHC) in AGEJ tissues before neoadjuvant chemotherapy. Chemotherapeutic efficacy was evaluated according to RECIST 1.0 standards and histopathological results, and the relationship between the expression of the cellular proteins and chemotherapy efficacy was analyzed. The SOX regimen was associated with an overall response rate of 46.2%. The frequency of expression of the seven cancer-associated factors in the AGEJ tissues was as follows: P-gp, 64.5%; GST-π, 39.8%; topo II, 72.0%; MRP, 33.3%; LRP, 68.8%; Ki-67, 62.4%; and p53, 40.9%. Expression of Ki-67 (p = 0.003) and p53 (p = 0.009) was significantly correlated with chemotherapy sensitivity. Elevated Ki-67 expression and decreased p53 expression predict for SOX insensitivity in AGEJ, and the cellular expression of these respective proteins may provide a useful reference for designing individualized chemotherapy regimens for AGEJ patients in the future.

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Background: The left thoracoabdominal (LTA) approach is the conventional way to treat adenocarcinoma of the esophagogastric junction (EGJ). The study was to review the outcome of the LTA approach with adenocarcinoma of the EGJ in a single institution in China. Methods: 135 consecutive adenocarcinomas of EGJ patients who underwent surgical treatment were retrospectively analyzed; data gathered included basic information on the tumor, surgical approach, postoperative complications and survival rate. Results: LTA esophagogastrectomy was performed in all patients. No patients received allogeneic blood transfusion during the operation. Among the resective procedures, proximal gastrectomy was performed in 122 cases. The mean operation time was 150 min (90–240). R₀ resection was obtained in 120 patients (88.9%). Two patients developed respiratory failure 2 days after surgery. Contrast swallow revealed a leak at the anastomosis in 2 patients. One early anastomotic stricture was observed radiologically, and pneumonia was observed in 3 patients. The number of patients with spontaneous pneumothorax and wound infections were 3 and 5, respectively. The percentage was zero in-hospital deaths. The overall survival rates at 1 year and 2 years were 89.2 and 69%, respectively. The median survival was 27.1 months. Conclusion: LTA esophagogastrectomy has a major role in the management of adenocarcinoma of the EGJ, at least in the northern Henan Province of China.

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