Abstract The incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising rapidly in recent years. AEG as an independent disease different from squamous cell carcinoma of the esophagus and gastric adenocarcinoma is getting acknowledged for most of scholars, with the distinctive anatomy location and involute recurrence and metastasis style. A higher rate of relapse and poor prognosis after resection become conscious since most of patients have been diagnosed with advanced disease, and adjuvant chemoradiotherapy needs to be valued further. But so far, there is no clinical data and subgroup analysis aimed at the value of postoperative treatment for AEG specially, leading to controversy is remaining in patients could get benefit from postoperative treatment, and delineation of the radiation target, etc. The design of the irradiation target should in terms of the clinical-pathological characteristics of the AEG, Siewert’s subtypes, the lymph node metastasis mapping and recurrence characteristics after surgery.
Corresponding Authors:
Department of Radiotherapy,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China
Cite this article:
Zhang Yanjun,Wang Jun,Cao Feng. Clinical and pathological features of esophageal and gastric junction adenocarcinoma and current status of postoperative adjuvant chemoradiotherapy[J]. Chinese Journal of Radiation Oncology, 2017, 26(3): 352-357.
Zhang Yanjun,Wang Jun,Cao Feng. Clinical and pathological features of esophageal and gastric junction adenocarcinoma and current status of postoperative adjuvant chemoradiotherapy[J]. Chinese Journal of Radiation Oncology, 2017, 26(3): 352-357.
[1] Jemal A,Murray T,Ward E,et al. Cancer statistics,2005[J].CA Cancer J Clin,2005,55(1):10-30.DOI:10.3322/canjclin.55.1.10. [2] Siewert JR,Feith M,Stein HJ.Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction:relevance of a topographic-anatomic subclassification[J].J Surg Oncol,2005,90(3):139-146.DOI:10.1002/jso.20218. [3] Bai JG,Lv Y,Dang CX.Adenocarcinoma of the Esophagogastric junction in China according to Siewert′s classification[J].Jpn J Clin Oncol,2006,36(6):364-367.DOI:10.1093/jjco/hyl042. [4] 徐宇,朱蕙燕,龙子雯,等.食管胃结合部腺癌的预后分析[J].中国癌症杂志,2010,20(6):446-451.DOI:10.3969/j.issn.1007-3639.2010.06.010. Xu Y,Zhu HY,Long ZW,et al. Prognostic analysis of adenocarcinoma of gastroesophageal junction[J]. Chin Oncol,2010,20(6):446-451.DOI:10.3969/j.issn.1007-3639.2010.06.010. [5] de Manzoni G,Pedrazzani C,Pasini F,et al. Pattern of recurrence after surgery in adenocarcinoma of the gastro-oesophageal junction[J].Eur J Surg Oncol,2003,29(6):506-510.DOI:10.1016/S0748-7983(03)00098-2. [6] Stahl M,Walz MK,Stuschke M,et al. Phase Ⅲ comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the Esophagogastric Junction[J].J Clin Oncol,2009,27(6):851-856.DOI:10.1200/JCO.2008.17.0506. [7] Cunningham D,Allum WH,Stenning SP,et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer[J].N Engl J Med,2006,355(1):11-20.DOI:10.1056/NEJMoa055531. [8] Ychou M,Boige V,Pignon JP,et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma:an FNCLCC and FFCD multicenter phase Ⅲ trial[J].J Clin Oncol,2011,29(13):1715-1721.DOI:10.1200/JCO.2010.33.0597. [9] Siewert JR,Hlscher AH,Becker K,et al. Cardia cancer:attempt at a therapeutically relevant classification[J].Chirurg,1987,58(1):25-32. [10] Yuasa N,Miyake H,Yamada T,et al. Clinicopathologic comparison of Siewert type Ⅱ and Ⅲ adenocarcinomas of the gastroesophageal junction[J].World J Surg,2006,30(3):364-371.DOI:10.1007/s00268-005-0434-x. [11] Hasegawa S,Yoshikawa T,Cho H,et al. Is adenocarcinoma of the Esophagogastric Junction different between Japan and western countries? The incidence and clinicopathological features at a Japanese high-volume cancer center[J].World J Surg,2009,33(1):95-103.DOI:10.1007/s00268-008-9740-4. [12] Pedrazzani C,de Manzoni G,Marrelli D,et al. Lymph node involvement in advanced gastroesophageal junction adenocarcinoma[J].J Thorac Cardiovasc Surg,2007,134(2):378-385.DOI:10.1016/j.jtcvs.2007.03.034. [13] Siewert JR,Stein HJ,Feith M.Adenocarcinoma of the esophago-gastric junction[J].Scand J Surg,2006,95(4):260-269. [14] Feith M,Stein HJ,Siewert JR.Adenocarcinoma of the esophagogastric junction:surgical therapy based on 1602 consecutive resected patients[J].Surg Oncol Clin North Am,2006,15(4):751-764.DOI:10.1016/j.soc.2006.07.015. [15] Chung JW,Lee GH,Choi KS,et al. Unchanging trend of esophagogastric junction adenocarcinoma in Korea:experience at a single institution based on Siewert′s classification[J].Dis Esophagus,2009,22(8):676-681.DOI:10.1111/j.1442-2050.2009.00946.x. [16] Nakamura T,Ide H,Eguchi R,et al. Adenocarcinoma of the esophagogastric junction:a summary of responses to a questionnaire on adenocarcinoma of the esophagus and the esophagogastric junction in Japan[J].Dis Esophagus,2002,15(3):219-225.DOI:10.1046/j.1442-2050.2002.00262.x. [17] Hosokawa Y,Kinoshita T,Konishi M,et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification:experiences at a single institution in Japan[J].Ann Surg Oncol,2012,19(2):677-683.DOI:10.1245/s10434-011-1983-x. [18] 武爱文,季加孚.明晰概念,规范食管胃结合部腺癌外科治疗[J].外科理论与实践,2013,18(1):4-6. Wu AW,Ji JF.Clear concept,The standardized surgical treatment of adenocarcinoma of the esophagogastric junction[J].J Surg Concept Pract,2013,18(1):4-6. [19] von Rahden BHA,Stein HJ,Siewert JR.Surgical management of esophagogastric junction tumors[J].World J Gastroenterol,2006,12(41):6608-6613.DOI:10.3748/wjg.v12.i41.6608. [20] Huang Q,Shi J,Feng AN,et al. Gastric cardiac carcinomas involving the esophagus are more adequately staged as gastric cancers by the 7th edition of the American Joint Commission on Cancer Staging System[J].Mod Pathol,2011,24(1):138-146.DOI:10.1038/modpathol.2010.183. [21] Chandrasoma P.What is adenocarcinoma of the esophagogastric junction?[J].Am J Gastroenterol,2008,103(2):492-493.DOI:10.1111/j.1572-0241.2007.01646_13.x. [22] Meier I,Merkel S,Papadopoulos T,et al. Adenocarcinoma of the esophagogastric junction:the pattern of metastatic lymph node dissemination as a rationale for elective lymphatic target volume definition[J].Int J Radiat Oncol Biol Phys,2008,70(5):1408-1417.DOI:10.1016/j.ijrobp.2007.08.053. [23] Ichikura T,Ogawa T,Kawabata T,et al. Is adenocarcinoma of the gastric cardia a distinct entity independent of subcardial carcinoma?[J].World J Surg,2003,27(3):334-338.DOI:10.1007/s00268-002-6776-8. [24] 王军,张彦军,刘青,等.食管胃结合部腺癌淋巴结转移规律对根治性放疗靶区勾画参考[J].中华放射肿瘤学杂志,2015,24(4):367-370.DOI:10.3760/cma.j.issn.1004-4221.2015.04.003. Wang J,Zhang YJ,Liu Q,et al. The patterns of lymph node metastasis in adenocarcinoma of esophagogastric junction:a reference for target volume delineation in radical radiotherapy[J].Chin J Radiat Oncol,2015,24(4):367-370.DOI:10.3760/cma.j.issn.1004-4221.2015.04.003. [25] 王军,张辛,韩春,等.根据胸段食管癌淋巴结转移规律探讨术后预防性照射范围和适应证[J].中华放射肿瘤学杂志,2009,18(4):265-269.DOI:10.3760/cma.j.issn.1004-4221.2009.04.265. Wang J,Zhang X,Han C,et al. Pattern of lymph node metastasis in determining the indication and target of post-operative prophylactic radiotherapy for thoracic esophageal carcinoma[J].Chin J Radiat Oncol,2009,18(4):265-269.DOI:10.3760/cma.j.issn.1004-4221.2009.04.265. [26] Dresner SM,Lamb PJ,Bennett MK,et al. The pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction[J].Surgery,2001,129(1):103-109.DOI:10.1067/msy.2001.110024. [27] Yamamoto M,Baba H,Egashira A,et al. Adenocarcinoma of the esophagogastric junction in Japan[J].Hepatogastroenterology,2008,55(81):103-107. [28] 李守淼,李子禹,季鑫.SiewertⅡ型胃食管结合部腺癌淋巴结转移的特点[J].中华肿瘤杂志,2013,35(4):288-291.DOI:10.3760/cma.j.issn.0253-3766.2013.04.010. Li SM,Li ZY,Ji X.Clinical characteristics of lymph node metastasis in Siewert type Ⅱ adenocarcinoma of the gastroesophageal junction[J].Chin J Oncol,2013,35(4):288-291.DOI:10.3760/cma.j.issn.0253-3766.2013.04.010. [29] 张彦军,王军,张小龙,等.393例食管胃结合部腺癌淋巴结转移的特征及其影响因素[J].中华肿瘤杂志,2016,38(9):672-676.DOI:10.3760/cma.j.issn.0253-3766.2016.09.007. Zhang YJ,Wang J,Zhang XL,et al. Distribution characteristics and influence factors of lymph node metastasis of the adenocarcinoma of esophagealgastric junction:an analysis of 393 patients[J].Chin J Oncol,2016,38(9):672-676.DOI:10.3760/cma.j.issn.0253-3766.2016.09.007. [30] Siewert JR,Stein HJ.Classification of adenocarcinoma of the oesophagogastric junction[J].Br J Surg,1998,85(11):1457-1459.DOI:10.1046/j.1365-2168.1998.00940.x. [31] Wayman J,Bennett MK,Raimes SA,et al. The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction[J].Br J Cancer,2002,86(8):1223-1229.DOI:10.1038/sj.bjc.6600252. [32] 王鑫,金晶,李晔雄,等.局部晚期胃癌根治术后复发部位分析及对术后放疗意义的探讨[J].中华放射肿瘤学杂志,2011,20(2):133-137.DOI:10.3760/cma.j.issn.1004-4221.2011.02.014. Wang X,Jin J,Li YX,et al. Analysis of recurrence for locally advanced gastric or gastroesophageal cancer patients after receiving curative gastrectomy (>D1) and its indication for adjuvant chemo radiotherapy[J].Chin J Radiat Oncol,2011,20(2):133-137.DOI:10.3760/cma.j.issn.1004-4221.2011.02.014. [33] GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group. Benefit of adjuvant chemotherapy for resectable gastric cancer:a meta-analysis[J].JAMA,2010,303(17):1729-1737.DOI:10.1001/jama.2010.534. [34] Sakuramoto S,Sasako M,Yamaguchi T,et al. Adjuvant chemotherapy for gastric cancer with S-1,an oral fluoropyrimidine[J].N Engl J Med,2007,357(18):1810-1820.DOI:10.1056/NEJMoa072252. [35] Bang YJ,Kim YW,Yang HK,et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC):a phase 3 open-label,randomised controlled trial[J].Lancet,2012,379(9813):315-321.DOI:10.1016/S0140-6736(11)61873-4. [36] Du CY,Zhou Y,Huang K,et al. Defining a high-risk subgrouPof pathological T2N0 gastric cancer by prognostic risk stratification for adjuvant therapy[J].J Gastrointest Surg,2011,15(12):2153-2158.DOI:10.1007/s11605-011-1684-6. [37] 罗居东,王建华,卢绪菁,等.胃癌根治术后放疗适应证的相关因素分析[J].肿瘤防治研究,2011,38(4):427-430.DOI:10.3971/j.issn.1000-8578.2011.04.016. Luo JD,Wang JH,Lu XQ,et al. Pathological Relative Risk Analysis for Postoperative Radiation in Gastric Cancer after Radical Gastrectomy[J].Chin J Cancer Prevent Treat,2011,38(4):427-430.DOI:10.3971/j.issn.1000-8578.2011.04.016. [38] 尚晓滨,于振涛.食管胃交界部腺癌:概念与对策[J].中国癌症杂志,2008,18(5):339-344.DOI:10.3969/j.issn.1007-3639.2008.05.004. Shang XB,Yu ZT.Adenocarcinoma of esophagogastricjunction:concept and strategy[J].Chin Oncol,2008,18(5):339-344.DOI:10.3969/j.issn.1007-3639.2008.05.004. [39] 饶健章,唐令超.食管胃连接处腺癌的临床病理问题[J].中国实用外科杂志,2008,28(5):392-394.DOI:10.3321/j.issn:1005-2208.2008.05.024. Rao JZ,Tang LC.The clinical pathological problems of gastroesophageal junction[J].Chin J Pract Surg,28(5):392-394.DOI:10.3321/j.issn:1005-2208.2008.05.024. [40] Macdonald JS,Smalley SR,Benedetti J,et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction[J].N Engl J Med,2001,345(10):725-730.DOI:10.1056/NEJMoa010187. [41] Macdonald JS,Benedetti J,Smalley S,et al. Chemoradiation of resected gastric cancer:a 10-year follow-uPof the phase Ⅲ trial INT0116(SWOG 9008)[J].J Clin Oncol,2009,27(15S):4515.DOI:10.1200/jco.2009.27.15 s.4515. [42] Kim S,Lim DH,Lee J,et al. An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach[J].Int J Radiat Oncol Biol Phys,2005,63(5):1279-1285.DOI:10.1016/j.ijrobp.2005.05.005. [43] Lee J,Lim DH,Kim S,et al. Phase Ⅲ trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection:the ARTIST trial[J].J Clin Oncol,2012,30(3):268-273.DOI:10.1200/JCO.2011.39.1953. [44] Park SH,Sohn TS,Lee J,et al. Phase Ⅲ trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer:final report of the adjuvant chemoradiotherapy in stomach tumors trial,including survival and subset analyses[J].J Clin Oncol,2015,33(28):3130-3136.DOI:10.1200/JCO.2014.58.3930. [45] Caudry M,Ratoanina J,Escarmant P,et al. Target volume in radiotherapy of gastric adenocarcinoma[J].Cancer Radiother,2001,5(5):523-533. [46] Hasegawa S,Yoshikawa T.Adenocarcinoma of the esophagogastric junction:incidence,characteristics,and treatment strategies[J].Gastric Cancer,2010,13(2):63-73.DOI:10.1007/s10120-010-0555-2. [47] Meyer W,PopPM,Klinger L,et al. Results of surgical therapy of adenocarcinomas of the esophagogastric junction according to a standardized surgical resection technique[J].Dig Surg,2002,19(4):269-275.DOI:10.1159/000064579. [48] Barbour AP,Rizk NP,Gonen M,et al. Adenocarcinoma of the gastroesophageal junction:influence of esophageal resection margin and operative approach on outcome[J].Ann Surg,2007,246(1):1-8.DOI:10.1097/01.sla.0000255563.65157.d2. [49] von Rahden BHA,Stein HJ,Feith M,et al. Lymphatic vessel invasion as a prognostic factor in patients with primary resected adenocarcinomas of the esophagogastric junction[J].J Clin Oncol,2005,23(4):874-879.DOI:10.1200/JCO.2005.12.151. [50] 张红丹,崔燕海,李伟雄.食管-胃结合部腺癌淋巴管侵犯与相关病理学因素关系研究[J].中国肿瘤临床,2008,35(13):736-738.DOI:10.3969/j.issn.1000-8179.2008.13.005. Zhang HD,Cui YH,Li WX.The Relationship between Lymphatic Vessel Invasion and Other Correlative Pathologic Factors in Adenocarcinoma of the Esophagus-gastric Junction[J].Chin J Clin Oncol,2008,35(13):736-738.DOI:10.3969/j.issn.1000-8179.2008.13.005. [51] Ielpo B,Pernaute AS,Elia S,et al. Impact of number and site of lymph node invasion on survival of adenocarcinoma of esophagogastric junction[J].Interact Cardiovasc Thorac Surg,2010,10(5):704-708.DOI:10.1510/icvts.2009.222778. [52] de Manzoni G,Pedrazzani C,Verlato G,et al. Comparison of old and new TNM systems for nodal staging in adenocarcinoma of the gastro-oesophageal junction[J].Br J Surg,2004,91(3):296-303.DOI:10.1002/bjs.4431.
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