Comparison of lymph node metastasis pattern from esophagogastric junction adenocarcinoma versus very low thoracic esophageal squamous cancer: a propensity-matched analysis

Abstract

Background: The anatomical locations of esophagogastric junction adenocarcinoma (AEG) and very low thoracic esophageal squamous cell carcinoma (ESCC) are similar. This study aimed to evaluate the difference in lymph node metastasis (LNM) distribution between AEG and very low thoracic ESCC.Methods: Data from 156 Siewert I-II AEG patients and 120 ESCC patients with proximal edges located within 5 cm of the esophagogastric junction (EGJ) and underwent curative surgery from 2010 to 2015 were retrospectively analyzed using propensity score matching (PSM). Five or six baseline variables were included in PSM separately. All patients underwent curative transthoracic surgery and systematic lymphadenectomy.After PSM, LNM rates of major stations were compared using the chi-squared test or Fisher's exact test.Results: After PSM was performed with covariates (age, sex, T stage, grade, tumor length), 60 pairs of patients were included. The lower mediastinal and total thoracic LNM rates of ESCC were significantly higher than those of AEG (18.3% vs. 3.3%, P=0.019; 25% vs. 3.3%, P=0.002). After further addition of the N stage as a variant to the previous PSM model, we found that the paracardial LNM distribution was significantly different between ESCC and AEG patients (36.1% vs. 19.7%, P=0.043). Among all tumor characteristics, only the T stage was positively correlated with paracardial LNM in ESCC (P=0.010), but not in AEG. In AEG, the median survival was poor for patients with thoracic LNM.Conclusions: Patients with very low thoracic ESCC exhibit stronger metastatic ability in the lower mediastinal and paracardial nodes than Siewert I-II AEG. However, the pathological metastasis of AEG in thoracic nodes was associated with poor survival outcomes.

Postoperative superior anastomotic leakage classification and treatment strategy for postoperative esophagogastric junction cancer

“…When the anastomosis is superior, leakage often leads to serious posterior mediastinal, thoracic, and abdominal infections, which greatly affects the short-term and long-term prognosis of these patients. Ma et al ( 8 ) reported that after radical gastrectomy, the incidence of anastomotic leakage was 6.3%, and the mortality related to anastomotic leakage reached 9%. Nagasako et al ( 9 ) found that the incidence of anastomotic complications in laparoscopic gastric cancer was 9.3%, and compared with patients without anastomotic complications, patients with anastomotic complications had a lower 5-year survival rate.…”

“…The analysis included treated patients classified according to the Siewert’s classification ( 8 ). In patients classified as AEG I, upper stomach resection with esophageal resection and esophagogastrostomy in the chest with D2+ lymphadenectomy was performed, while in the AEG II and III group, gastrectomy with D2 lymphadenectomy was undertaken.…”

Mechanisms of esophageal cancer metastasis and treatment progress

“…A study in 2023 comparing lymph node metastasis patterns between adenocarcinoma of the esophagogastric junction (AEG) and lower thoracic esophageal squamous cell carcinoma (ESCC) found that ESCC was more likely to invade the lower mediastinal and paracardial lymph nodes than AEG. The presence of lymph node metastasis in these regions in AEG indicates a stage T3 or higher, necessitating complete lymph node clearance of the lower mediastinum and abdomen in advanced AEG ( 21 ).…”

The different routes of lymph node metastases in esophageal cancer and its significance

“…In a study recently published by Ma et al entitled “Comparison of lymph node metastasis pattern from esophagogastric junction adenocarcinoma versus very low thoracic esophageal squamous cancer: a propensity-matched analysis”, the authors sought to compare patients presenting with very low thoracic esophageal squamous cell carcinoma (ESCC) to those presenting with esophagogastric junction adenocarcinoma (AEG) ( 6 ). In this study, the authors recorded the patterns of lymph node metastases with very low ESCC versus AEG and overall outcomes.…”