Journal of Gastric Cancer

  • 제24권3호
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  • Pages.267-279
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  • 2024
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Diffuse-Type Histology Is Prognostic for All Siewert Types of Gastroesophageal Adenocarcinoma

  • Kelly M Mahuron (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Kevin M Sullivan (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Matthew C Hernandez (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Yi-Jen Chen (Department of Radiation Oncology, City of Hope National Medical Center) ;
  • Joseph Chao (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Laleh G Melstrom (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • I. Benjamin Paz (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Jae Yul Kim (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Rifat Mannan (Division of Thoracic Surgery, Department of Surgery, City of Hope National Medical Center) ;
  • James L. Lin (Department of Pathology, City of Hope National Medical Center) ;
  • Yuman Fong (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center) ;
  • Yanghee Woo (Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center)
  • 투고 : 2023.12.29
  • 심사 : 2024.04.22
  • 발행 : 2024.07.01
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초록

Purpose: The optimal treatment for gastroesophageal junction adenocarcinoma (GEJA) remains controversial. We evaluated the treatment patterns and outcomes of patients with locally advanced GEJA according to the histological type. Materials and Methods: We conducted a single-institution retrospective cohort study of patients with locally advanced GEJA who underwent curative-intent surgical resection between 2010 and 2020. Perioperative therapies as well as clinicopathologic, surgical, and survival data were collected. The results of endoscopy and histopathological examinations were assessed for Siewert and Lauren classifications. Results: Among the 58 patients included in this study, 44 (76%) were clinical stage III, and all received neoadjuvant therapy (72% chemoradiation, 41% chemotherapy, 14% both chemoradiation and chemotherapy). Tumor locations were evenly distributed by Siewert Classification (33% Siewert-I, 40% Siewert-II, and 28% Siewert-III). Esophagogastrectomy (EG) was performed for 47 (81%) patients and total gastrectomy (TG) for 11 (19%) patients. All TG patients received D2 lymphadenectomy compared to 10 (21%) EG patients. Histopathological examination showed the presence of 64% intestinal-type and 36% diffuse-type histology. The frequencies of diffuse-type histology were similar among Siewert groups (37% Siewert-I, 36% Siewert-II, and 33% Siewert-III). Regardless of Siewert type and compared to intestinal-type, diffuse histology was associated with increased intraabdominal recurrence rates (P=0.03) and decreased overall survival (hazard ratio, 2.33; P=0.02). With a median follow-up of 31.2 months, 29 (50%) patients had a recurrence, and the median overall survival was 50.5 months. Conclusions: Present in equal proportions among Siewert types of esophageal and gastric cancer, a diffuse-type histology was associated with high intraabdominal recurrence rates and poor survival. Histopathological evaluation should be considered in addition to anatomic location in the determination of multimodal GEJA treatment strategies.

키워드

과제정보

Research reported in this publication included work performed at the City of Hope Research Pathology Informatics Shared Resource supported by the National Cancer Institute of the National Institutes of Health under grant number P30CA033572. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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