Does Pathological Stage and Nodal Involvement Influence Long Term Oncological Outcomes after CROSS Regimen for Adenocarcinoma of the Esophagogastric Junction? A Multicenter Retrospective Analysis

Pascale, Stefano De; Valmasoni, Michele; Weindelmayer, Jacopo; Terraneo, Fabrizia; Cella, Chiara Alessandra; Giacopuzzi, Simone; Cossu, Andrea; Massaron, Simonetta; Elmore, Ugo; Merigliano, Stefano; Romario, Uberto Fumagalli

doi:10.3390/cancers13040666

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“…Tumors with epicenters located more than 2 cm below the GEJ into the proximal stomach (i.e., Siewert type III GEJ cancers) are staged as gastric cancers, whereas those with epicenters located more than 2 cm above or within 2 cm of the GEJ (i.e., Siewert type I and type II cancers, respectively) are staged as esophageal cancers. The use of different staging systems based only on the location of the tumor's epicenter does not effectively guide medical and surgical strategies, while it causes misclassification and may lead to inaccurate prognostic predictions [7,8].…”

Section: Introductionmentioning

confidence: 99%

Independent Stage Classification for Gastroesophageal Junction Adenocarcinoma

Hirata,

Chiang,

Estrella

et al. 2023

Cancers

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In gastroesophageal junction (GEJ) adenocarcinoma cases, a prognosis based on ypTNM staging could be affected by preoperative therapy. Patients with esophageal adenocarcinoma and gastric adenocarcinoma who underwent preoperative therapy followed by surgical resection from 2006 through 2017 were identified in the National Cancer Database. To enable stage-by-stage OS comparisons, tumors were classified into four gross ypTNM groups: ypT1/2, N-negative; ypT1/2, N-positive; ypT3/4, N-negative; and ypT3/4, N-positive. Prognostic factors were examined, and an OS prediction nomogram was developed for patients with abdominal/lower esophageal and gastric cardia adenocarcinoma, representing GEJ cancers. We examined 25,463 patient records. When compared by gross ypTNM group, the abdominal/lower esophageal and gastric cardia adenocarcinoma groups had similar OS rates, differing from those of other esophageal or gastric cancers. Cox regression analysis of patients with GEJ cancers showed that preoperative chemoradiotherapy was associated with shorter OS than preoperative chemotherapy after adjustment for the ypTNM group (hazard ratio 1.31, 95% CI 1.24–1.39, p < 0.001), likely owing to downstaging effects. The nomogram had a concordance index of 0.833 and a time-dependent area under the curve of 0.669. OS prediction in GEJ adenocarcinoma cases should include preoperative therapy regimens. Our OS prediction nomogram provided reasonable OS prediction for patients with GEJ adenocarcinoma, and future validation is needed.

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Section: Introductionmentioning

confidence: 99%