Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

Table 1 Baseline characteristics of patients and therapeutic approaches (n = 83) n (%)

	Type II (n = 62)	Type III (n = 21)	P value
Age (yr)			0.72
Median (range)	68.5 (33-87)	69 (54-80)
Sex			0.78
Male	49 (79)	16 (76)
Female	13 (21)	5 (24)
Tumor size (mm)	50 (10-168)	70 (12-120)	0.016
Esophageal invasion (mm)	9 (0-85)	5 (0-15)	0.024
Total number of examined lymph nodes	36.5 (5-96)	51 (22-80)	0.016
Approach
Right thoracic	8 (13)	0 (0)
Left thoracic	8 (13)	1 (5)
Transhiatal	46 (74)	20 (95)
Resection method
Subtotal esophagectomy	8 (13)	0 (0)
Total gastrectomy with distal esophagectomy	37 (60)	21 (100)
Proximal gastrectomy with distal esophagectomy	17 (27)	0 (0)
Adjuvant chemotherapy			0.24
Yes	19 (31)	9 (43)
No	43 (69)	12 (57)

Type II: Siewert type II adenocarcinoma of the esophagogastric junction; Type III: Siewert type III adenocarcinoma of the esophagogastric junction.

Table 2 Pathological characteristics of patients (n = 83) n (%)

	Type II(n = 62)	Type III(n = 21)	P value
T category			0.06
T1b	11 (18)	0 (0)
T2	11 (18)	2 (10)
T3	40 (64)	19 (90)
N category			0.41
N0	21 (34)	4 (19)
N1	12 (19)	6 (29)
N2	13 (21)	3 (14)
N3	14 (23)	6 (29)
LNR	0.063 (0-1)	0.047 (0-0.41)	0.74
M category			0.64
M0	58 (94)	19 (90)
M1	4 (6)	2 (10)
TNM stage			0.30
IA	10 (16)	0 (0)
IB	5 (8)	0 (0)
IIA	6 (10)	4 (19)
IIB	5 (8)	1 (5)
IIIA	8 (13)	5 (24)
IIIB	11 (18)	3 (14)
IIIC	12 (19)	6 (29)
IV	5 (8)	2 (10)
ly category			0.35
ly0	8 (13)	0 (0)
ly1	16 (26)	5 (24)
ly2	22 (35)	9 (43)
ly3	16 (26)	7 (33)
v category			0.55
v0	7 (11)	3 (14)
v1	13 (21)	4 (19)
v2	24 (39)	5 (24)
v3	18 (29)	9 (43)
Histopathological grade			0.56
G1 + G2	37 (60)	11 (52)
G3 + G4	25 (40)	10 (48)

Type II: Siewert type II adenocarcinoma of the esophagogastric junction; Type III: Siewert type III adenocarcinoma of the esophagogastric junction; LNR: Lymph node ratio; ly: Lymphatic invasion; v: Venous invasion.

Table 3 Incidence, 5-year survival rate, and index of estimated benefit from lymph node dissection

Lymph node	Type II		Type III		Total
station	Number of patients with dissection	Number of patients with metastasis	Number of patients with dissection	Number of patients with metastasis	Number of patients with dissection	Number of patients with metastasis	5-yr survival rate	IEBLD
1	62	27	21	11	83	38	49.70%	22.8
2	62	14	21	5	83	19	50.70%	11.6
3	62	27	21	14	83	41	53.70%	26.5
4sa	42	1	18	0	60	1	0	0.0
4sb	43	1	19	1	62	2	100%	3.2
4d	39	0	20	0	59	0	NA	0.0
5	25	0	14	1	39	1	0	0.0
6	31	0	21	0	52	0	NA	0.0
7	58	17	21	6	79	23	36.30%	10.6
8	42	4	21	2	63	6	20.80%	2.0
9	32	5	14	2	46	7	42.90%	6.5
10	28	3	12	0	40	3	66.70%	5.0
11p	33	4	19	0	52	4	33.30%	2.6
11d	24	4	11	1	35	5	60%	8.6
12	2	0	1	0	3	0	NA	0.0
16	2	0	0	0	2	0	NA	0.0
LMLN	13	5	3	0	16	5	20%	6.3
MMLN	8	1	0	0	8	1	0	0.0
UMLN	7	1	0	0	7	1	0	0.0

IEBLD: Index of the estimated benefit of lymph-node dissection; Type II: Siewert type II adenocarcinoma of the esophagogastric junction; Type III: Siewert type III adenocarcinoma of the esophagogastric junction; LMLN: Lower mediastinal lymph-node; MMLN: Middle mediastinal lymph-node; UMLN: Upper mediastinal lymph-node.

Table 4 Prognostic analysis in patients with adenocarcinoma of the esophagogastric junction

Category	Classification	Univariate analysis				Multivariate analysis
		n	Proportion	5 yr-OS	P value	HR	95%CI	P value
Age (yr)	< 65	29	35%	67%	0.084			0.47
	≥ 65	54	65%	52%
Sex	Male	65	78%	56%	0.57
	Female	18	22%	67%
Siewert type	II	62	75%	58%	0.88
	III	21	25%	57%
Esophageal invasion	≤ 3 cm	73	88%	60%	0.21
	> 3 cm	10	12%	40%
Tumor size	< 6 cm	45	54%	58%	0.86
	≥ 6 cm	38	46%	58%
pT	pT1-2	24	29%	77%	0.01a			0.88
	pT3	59	71%	50%
pN	pN0	25	30%	78%	0.028a			0.30
	pN1-3	58	70%	49%
Mediastinal LN meta	No	78	94%	60%	0.007a			0.17
	Yes	5	6%	20%
LNR	< 0.16	59	71%	71%	< 0.001a			0.001a
	> 0.16	24	29%	23%		4.29	1.79-10.89
ly	ly0, 1	29	35%	69%	0.059			0.13
	ly2, 3	54	65%	52%
v	v0, 1	27	33%	83%	< 0.001a			0.004a
	v2, 3	56	67%	46%		5.99	1.71-24.90
Histopathological Grade	G1 + G2	48	58%	60%	0.28
	G3 + G4	35	42%	55%
Adjuvant chemotherapy	No	54	65%	56%	0.52
	Yes	29	35%	61%
Residual tumor	R0	74	89%	62%	< 0.001a			0.056
	R1	9	11%	22%		2.61	0.97-6.59

AEG: Adenocarcinoma of the esophagogastric junction; OS: Overall survival; HR: Hazard ratio; LNR: Lymph node ratio; ly: Lymphatic invasion; v: Venous invasion.

^aP < 0.05.