J Gastric Cancer.
2024 Jul;24(3):267-279. 10.5230/jgc.2024.24.e20.
Diffuse-Type Histology Is Prognostic for All Siewert Types of Gastroesophageal Adenocarcinoma
- Mahuron KM
1 - Sullivan KM1
- Hernandez MC1
- Chen YJ2
- Chao J1
- Melstrom LG1
- Paz IB1
- Kim JY1
- Mannan R3
- Lin JL4,5
- Fong Y1
- Woo Y1,6
- Affiliations
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- 1Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
- 2Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
- 3Division of Thoracic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
- 4Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
- 5Division of Gastroenterology, Department of Medicine, City of Hope National Medical Center, Duarte, CA, USA
- 6Cancer Immunotherapeutics Program, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
- KMID: 2560568
- DOI: http://doi.org/10.5230/jgc.2024.24.e20
Abstract
- 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.
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