Is advanced esophageal adenocarcinoma a distinct entity from intestinal subtype gastric cancer? Data from the AGAMENON-SEOM Registry

Abstract

Background Advanced esophageal adenocarcinoma (EAC) is generally treated similarly to advanced gastroesophageal junction (GEJ-AC) and gastric (GAC) adenocarcinomas, although GAC clinical trials rarely include EAC. This work sought to compare clinical characteristics and treatment outcomes of advanced EAC with those of GEJ-AC and GAC and examine prognostic factors. Patients and methods Participants comprised patients with advanced EAC, intestinal GEJ-AC, and GAC treated with platin and fluoropyrimidine (plus trastuzumab when HER2 status was positive). Overall and progression-free survival were estimated using the Kaplan-Meier method. Cox proportional hazards regression gauged the prognostic value of the AGA-MENON model. Results Between 2008 and 2019, 971 participants from the AGAMENON-SEOM registry were recruited at 35 centers. The sample included 67.3% GAC, 13.3% GEJ-AC, and 19.4% EAC. Pulmonary metastases were most common in EAC and peritoneal metastases in GAC. Median PFS and OS were 7.7 (95% CI 7.3-8.0) and 13.9 months (12.9-14.7). There was no difference in PFS or OS between HER2− and HER2+ tumors from the three locations (p > 0.05). Five covariates were found to be prognostic for the entire sample: ECOG-PS, histological grade, number of metastatic sites, NLR, and HER2+ tumors treated with trastuzumab. In EAC, the same variables were prognostic except for grade. The favorable prognosis for HER2+ cancers treated with trastuzumab was homogenous for all three subgroups (p = 0.351) and, after adjusting for the remaining covariates, no evidence supported primary tumor localization as a prognostic factor (p = 0.331). Conclusion Our study supports the hypothesis that EAC exhibits clinicopathological characteristics, prognostic factors, and treatment outcomes comparable to intestinal GEJ-AC and GAC.

Patients with esophageal adenocarcinoma showed better prognosis than those with adenocarcinoma of the gastroesophageal junction

“…While there were several similar clinicopathological and prognostic characteristics (Table 2), as reported previously, 19 EAC patients, compared to AGEJ patients, exhibited a significantly higher prevalence of gastroesophageal reflux disease, long-segment BE, detection of cancer during endoscopic surveillance, smaller tumor size, more favorable histological features, earlier stages, better OS, DFS and RFS, and significantly higher 5-and 10-year OS rates. Our data parallel the results of previous studies 20,21 but differ from the conclusions of a recent Spanish investigation on advanced EAC and GEJ carcinoma, 22 which excluded uncommon signet-ring cell carcinoma and mixed carcinomas that are well known to have a dismal prognosis.…”

Sex and gender disparities in patients with advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry

“…The main characteristics of the registry, method, and data collection have been reported elsewhere. 6 , 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 In brief, the AGAMENON-SEOM is a registry sponsored by SEOM’s Evaluation of Results and Clinical Practice section. It is an observational, noninterventionistic registry of the diagnostic–therapeutic approach according to each participating center’s usual practice.…”

“…Consequently, epidemiological and therapeutic research on gastroesophageal cancer may be influenced by the preponderance of men, 1 , 2 , 5 , 6 , 7 but data regarding the impact of sex on survival outcomes are inconclusive. 6 , 8 , 9 Apart from raw epidemiological and therapeutic results, usually considering sex differences in subgroup analyses, a deeper evaluation of diagnosis, patterns of disease at diagnosis, and treatment strategies could help to explore and explain how gender, beyond sex, may influence disease presentation, treatment approach, and, ultimately, treatment outcomes.…”

Relationships among microbiota, gastric cancer, and immunotherapy

“…About 50% of cases develop local recurrence or systemic metastasis after adjuvant treatment, and only 10–15% of the cases have an overall survival (OS) of 5 years. Metastases are primarily treated with palliative chemotherapy, leaving a lower median survival rate of about 8–10 months ( Nishikawa et al, 1990 , 2019 ; Alvarez-Manceñido et al, 2021 ). Among the currently used targeted drugs, only Trastuzumab and Ramucirumab have shown beneficial results in improving OS ( Lazăr et al, 2018 ).…”

“…chemotherapy, leaving a lower median survival rate of about 8-10 months (Nishikawa et al, 1990(Nishikawa et al, , 2019Alvarez-Manceñido et al, 2021). Among the currently used targeted drugs, only Trastuzumab and Ramucirumab have shown beneficial results in improving OS (Lazȃr et al, 2018).…”