Article

Should adenocarcinoma of the esophagogastric junction be classified as esophageal cancer? A comparative analysis according to the seventh AJCC TNM classification.

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Annals of surgery (impact factor: 7.9). 05/2012; 255(5):908-15. DOI:10.1097/SLA.0b013e31824beb95
Source: PubMed

ABSTRACT The aim of this study was to evaluate the adequacy of esophageal classification for adenocarcinoma of the esophagogastric junction (AEJ) of the seventh American Joint Committee on Cancer (AJCC) TNM classification.
The seventh AJCC TNM classification proposed the new classification for AEJ as a part of esophageal cancer depending on the esophagogastric junction (EGJ) involvement. However, there are still many controversies over the classification system for AEJ.
A review of pathologic reports and photographic findings at Seoul National University Hospital from 2003 to 2009 identified 4524 patients with single, primary adenocarcinoma of the EGJ (n = 497) and other regions of the stomach (GC, n = 4027) who underwent an operation with curative intent. We analyzed the clinicopathologic features and postoperative prognosis of AEJ using the Siewert classification and the seventh AJCC TNM classification.
There was no Siewert type I (AEJ I) in this study. The prognosis of AEJ was similar to that of GC. There was no difference in clinicopathologic features between AEJ II and AEJ III. Even though AEJ extending into the EGJ (AEJe) showed more advanced pathologic features than AEJ not extending into the EGJ (AEJg), the prognosis of AEJe and AEJg was not significantly different when stratified by T stage. Compared with the classification of gastric cancer applied for AEJ, esophageal classification for AEJ from the seventh AJCC TNM classification showed a loss of distinctiveness at each TNM stage.
To evaluate the postoperative prognosis of AEJ within the stomach, AEJ II and AEJ III should be considered a part of gastric cancer irrespective of EGJ involvement.

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Keywords

AEJ II
 
AEJ III
 
classification system
 
clinicopathologic features
 
controversies
 
curative intent
 
esophageal classification
 
esophagogastric junction
 
new classification
 
pathologic features
 
pathologic reports
 
photographic findings
 
postoperative prognosis
 
primary adenocarcinoma
 
Seoul National University Hospital
 
seventh AJCC TNM classification
 
seventh American Joint Committee
 
Siewert classification
 
Siewert type
 
stratified
 

Yun-Suhk Suh