Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Abstract

Background: Multimodality treatment options in locally advanced adenocarcinomas of the esophagogastric junction (AEGs) have been established in the last years. However, the therapeutic approach in patients with clinically staged cT2 tumors remains controversial. The most important determinant is the accuracy of clinical staging. We aimed to evaluate the association of clinical and histopathological staging in patients with cT2 tumors in respect of possible therapeutic consequences. Patients and Methods: Between 2001 and 2011, 71 patients with AEG tumors were clinically staged as cT2 (cN0 = 48 (68%); cN+ = 23 (32%)) and underwent surgical resection. Results: A primary tumor resection was performed in 59 (83%) patients while 12 (17%) patients received neoadjuvant therapy. Primarily resected patients showed the following pT/pN categories: pT1: 13 (22%), pT2: 35 (59%), pT3: 11 (19%), pN0: 23 (39%), whereas the clinical/histopathological pN category included 55% of the patients. Neoadjuvantly treated patients showed the following pT/pN categories: ypT0: 3 (25%), ypT1: 3 (25%), ypT2: 6 (50%), ypN0: 6 (50%). The overall survival of primarily resected patients compared with patients undergoing neoadjuvant therapy was not significantly different. Conclusions: The accuracy of clinical staging in patients with cT2 tumors of the gastroesophageal junction is poor. As in primarily resected patients, over- and understaging balance each other; correct pretherapeutic staging occurs in just about 60% of the patients. Moreover, our study suggests that a radical surgical resection with adequate lymphadenectomy seems to be appropriate for cT2N0 and even in cT2N+ tumors, since down-categorizing and prognosis are not improved for neoadjuvantly treated patients. However, the data have to be interpreted with caution because of the small patient numbers.

Exploring diagnostic and therapeutic implications of endoscopic mucosal resection in EUS-staged T2 esophageal adenocarcinoma

“…Accurate tumor staging is crucial in establishing the appropriate choice of treatment. EUS is superior to CT and PET in delineating the esophageal wall layers and determining the appropriate T stage [5,23,24], but it has poor accuracy when differentiating T2 from T1 tumors, with a sensitivity of 43 % -55 % and specificity of 80 % -85 % [13,14]. In our surgical cohort, 44 % of cT2 EACs could be downstaged to pT1 tumors based on the final pathology report, which is a similar finding to previous studies reporting downstaging in 21 % -63 % of cases [3,6,15,25].…”

“…EUS is accurate in staging T3 and T4 tumors and locoregional LNM, but the accuracy is lower when it comes to differentiating T2 from T1 tumors, with a sensitivity of 43 % -55 % and a specificity of 80 % -85 % [13,14]. In T2 tumors that are inaccurately staged by EUS, the final pathology reveals a pathological (p)T0 -1 stage in 21 % -63 % and a pT3 -4 N0 or pT any N1 -N3 in 19 % -50 % [5,6,15].…”

Diverse ‘just-right’ levels of chromosomal instability and their clinical implications in neoadjuvant treated gastric cancer

“…Follow-up was performed as described and median follow-up was calculated by the inverse Kaplan–Meier method [ 14 , 16 ]. OS of the patients was defined as the time between the date of surgery and death by any cause [ 3 , 14 ].…”

A novel pretherapeutic gene expression-based risk score for treatment guidance in gastric cancer

“…Follow-up was carried out as described and median follow-up was calculated by the inverse Kaplan-Meier method [6,15]. The primary end point of the study was overall survival (OS), which was defined as the time between the date of operation and death by any cause.…”

“…Clinical staging, which forms the sole basis for patient selection for this treatment is generally known to be imprecise. In particular, the accuracy of clinical staging for patients with cT2 adenocarcinomas of the gastro-esophageal junction (AEG) was demonstrated to be poor [6]. Undertreatment of patients with exceptionally aggressive prognostically bad cT1/cT2 tumors and overtreatment of patients with less aggressive and prognostically favorable cT3/cT4 tumors cannot be excluded.…”