Predictors of Lymph Node Metastasis in Siewert Type II T1 Adenocarcinoma of the Esophagogastric Junction: A Population-Based Study

Overview

Journal Cancer Control

Specialty Oncology

Date 2021 Jun 22

PMID 34155922

Citations 8

Authors

Liubo Chen

Kejun Tang

Sihan Wang

Dongdong Chen

Kefeng Ding

Affiliations

Soon will be listed here.

Abstract

Background: Endoscopic resection has been introduced as an alternative treatment for superficial adenocarcinoma of the esophagogastric junction (AEG), but is limited by positive nodal status. We aimed to investigate the predictors of lymph node metastasis (LNM) in patients with Siewert type II T1 AEG.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify eligible patients with Siewert type II T1 AEG. The prevalence of LNM was assessed. Logistic regression analysis with multivariable adjustment was used to determine predictors of LNM. We also performed Cox regression analysis to examine the prognostic value of LNM, which was further confirmed by competing risk analysis and cumulative incidence function (CIF).

Results: In total, 2651 patients with T1 AEG were included, with a median age of 69 years and a median follow-up of 28 months. The overall prevalence of LNM was 17.2% in T1 AEG. When stratified by tumor invasion depth, the prevalence of LNM was 8.5% for intramucosal tumors and 22.6% for submucosal tumors. Adjusted logistic regression analysis showed that age, sex, tumor grade, tumor size and tumor infiltration depth were independent predictors of LNM in T1 AEG. Multivariate Cox regression analysis revealed that positive nodal status was significantly associated with worse overall survival and cancer-specific survival (CSS). Subgroup analysis consistently demonstrated that patients with LNM had significantly poorer CSS than those without LNM in most subgroups. Finally, the CIF was calculated, showing that patients with LNM had a significantly higher cancer-specific death rate than those without LNM.

Conclusions: This population-based study identified age, sex, tumor grade, tumor infiltration depth and tumor size as independent predictors of LNM in T1 AEG. Considering the high prevalence of LNM in T1 AEG, endoscopic resection for curative aims may only be introduced in patients without high risks of LNM.

Citing Articles

The development and validation of automated machine learning models for predicting lymph node metastasis in Siewert type II T1 adenocarcinoma of the esophagogastric junction.

Lu C, Liu L, Yin M, Lin J, Zhu S, Gao J Front Med (Lausanne). 2024; 11:1266278.

PMID: 38633305 PMC: 11021582. DOI: 10.3389/fmed.2024.1266278.

Marital Status Is a Prognostic Factor for Cardiovascular Mortality but Not a Prognostic Factor for Cancer Mortality in Siewert Type II Adenocarcinoma of the Esophagogastric Junction.

Zheng Z, Sun X Gastroenterology Res. 2024; 16(6):307-317.

PMID: 38186587 PMC: 10769607. DOI: 10.14740/gr1670.

Influence of Primary Tumor Resection on Survival of Patients With Metastatic Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Population-Based, Propensity-Matched Analysis.

Chen J, Jia X, Chen H, Cai J, Chen L Cancer Control. 2023; 30:10732748231208313.

PMID: 37851478 PMC: 10588414. DOI: 10.1177/10732748231208313.

The Long-Term Outcomes of Surgery Versus Endoscopic Treatment in Patients With Siewert Type II T1M0N0 Adenocarcinoma of the Esophagogastric Junction.

Chen H, Yu X, Yang R, Li S, Zhang G, Si X Cancer Control. 2022; 29:10732748221143389.

PMID: 36523149 PMC: 9761803. DOI: 10.1177/10732748221143389.

Predictors of Long-Time Survivors in Nonmetastatic Colorectal Signet Ring Cell Carcinoma: A Large Population-Based Study.

Zhang W, Gong W, Wu C, Li M, Tu X Gastroenterol Res Pract. 2022; 2022:5393571.

PMID: 36032271 PMC: 9402301. DOI: 10.1155/2022/5393571.

References

Xie S, Lagergren J . The Male Predominance in Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol. 2015; 14(3):338-347.e1. DOI: 10.1016/j.cgh.2015.10.005. View

Ahmadi O, Stringer M, Black M, McCall J . Influence of age and site of disease on lymph node yield in colorectal cancer. N Z Med J. 2014; 127(1395):31-40. View

Dignam J, Zhang Q, Kocherginsky M . The use and interpretation of competing risks regression models. Clin Cancer Res. 2012; 18(8):2301-8. PMC: 3328633. DOI: 10.1158/1078-0432.CCR-11-2097. View

Chen K, Deng X, Yang Z, Yu D, Zhang X, Zhang J . Survival nomogram for patients with metastatic siewert type II adenocarcinoma of the esophagogastric junction: a population-based study. Expert Rev Gastroenterol Hepatol. 2020; 14(8):757-764. DOI: 10.1080/17474124.2020.1784726. View

Kim H, Chung H, Shin S, Kim H, Park J, Lee S . Comparison of long-term clinical outcomes between endoscopic and surgical resection for early-stage adenocarcinoma of the esophagogastric junction. Surg Endosc. 2018; 32(8):3540-3547. DOI: 10.1007/s00464-018-6076-5. View

Siewert J, Stein H, Feith M . Adenocarcinoma of the esophago-gastric junction. Scand J Surg. 2007; 95(4):260-9. DOI: 10.1177/145749690609500409. View

Ancona E, Rampado S, Cassaro M, Battaglia G, Ruol A, Castoro C . Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol. 2008; 15(11):3278-88. DOI: 10.1245/s10434-008-0065-1. View

Pyo J, Lee H, Min Y, Min B, Lee J, Kim K . Young Age and Risk of Lymph Node Metastasis in Differentiated Type Early Gastric Cancer. Ann Surg Oncol. 2018; 25(9):2713-2719. DOI: 10.1245/s10434-018-6659-3. View

de Glas N, Kiderlen M, Vandenbroucke J, de Craen A, Portielje J, van de Velde C . Performing Survival Analyses in the Presence of Competing Risks: A Clinical Example in Older Breast Cancer Patients. J Natl Cancer Inst. 2015; 108(5). DOI: 10.1093/jnci/djv366. View

10.

Zhang Y, Wang J, Zhang X, Liu Q, Jing S, Wang Y . [Patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction in 393 patients]. Zhonghua Zhong Liu Za Zhi. 2016; 38(9):672-6. DOI: 10.3760/cma.j.issn.0253-3766.2016.09.007. View

11.

Dubecz A, Kern M, Solymosi N, Schweigert M, Stein H . Predictors of Lymph Node Metastasis in Surgically Resected T1 Esophageal Cancer. Ann Thorac Surg. 2015; 99(6):1879-85. DOI: 10.1016/j.athoracsur.2015.02.112. View

12.

von Rahden B, Feith M, Stein H . Carcinoma of the cardia: classification as esophageal or gastric cancer?. Int J Colorectal Dis. 2005; 20(2):89-93. DOI: 10.1007/s00384-004-0646-9. View

13.

Xu X, Zhang C, Ni X, Wu J, Pan C, Wang S . Population-based analysis on predictors for lymph node metastasis in T1 colon cancer. Surg Endosc. 2019; 34(9):4030-4040. PMC: 7395001. DOI: 10.1007/s00464-019-07192-0. View

14.

Sugita S, Kinoshita T, Kuwata T, Tokunaga M, Kaito A, Watanabe M . Long-term oncological outcomes of laparoscopic versus open transhiatal resection for patients with Siewert type II adenocarcinoma of the esophagogastric junction. Surg Endosc. 2020; 35(1):340-348. DOI: 10.1007/s00464-020-07406-w. View

15.

Miccio J, Oladeru O, Yang J, Xue Y, Choi M, Zhang Y . Neoadjuvant vs. adjuvant treatment of Siewert type II gastroesophageal junction cancer: an analysis of data from the surveillance, epidemiology, and end results (SEER) registry. J Gastrointest Oncol. 2016; 7(3):403-10. PMC: 4880769. DOI: 10.21037/jgo.2015.10.06. View

16.

Turkington R, Parkes E, Kennedy R, Eatock M, Harrison C, McCloskey P . Clinical tumor staging of adenocarcinoma of the esophagus and esophagogastric junction. J Clin Oncol. 2015; 33(9):1088. DOI: 10.1200/JCO.2014.59.2402. View

17.

Austin P, Lee D, Fine J . Introduction to the Analysis of Survival Data in the Presence of Competing Risks. Circulation. 2016; 133(6):601-9. PMC: 4741409. DOI: 10.1161/CIRCULATIONAHA.115.017719. View

18.

Zhang X, Watson D, Jamieson G, Lally C, Bessell J, Devitt P . Outcome of oesophagectomy for adenocarcinoma of the oesophagus and oesophagogastric junction. ANZ J Surg. 2005; 75(7):513-9. DOI: 10.1111/j.1445-2197.2005.03433.x. View

19.

Li R, Chen T, Hu J, Guo D, Zhang X, Deng D . Tumor volume of resectable adenocarcinoma of the esophagogastric junction at multidetector CT: association with regional lymph node metastasis and N stage. Radiology. 2013; 269(1):130-8. DOI: 10.1148/radiol.13122269. View

20.

Hirasawa K, Kokawa A, Oka H, Yahara S, Sasaki T, Nozawa A . Superficial adenocarcinoma of the esophagogastric junction: long-term results of endoscopic submucosal dissection. Gastrointest Endosc. 2010; 72(5):960-6. DOI: 10.1016/j.gie.2010.07.030. View