Review
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World J Gastroenterol. Dec 28, 2012; 18(48): 7134-7140
Published online Dec 28, 2012. doi: 10.3748/wjg.v18.i48.7134
Carcinoma of the gastroesophageal junction in Chinese patients
Qin Huang
Qin Huang, Department of Pathology, Nanjing Drum Tower Hospital, Nanjing 020008, Jiangsu Province, China
Qin Huang, Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA 02132, United States
Author contributions: Huang Q designed, executed the studies, and wrote the manuscript.
Supported by Science and Technology Development Project of the Nanjing City in China, No. ZKX05013, No. ZKX07011; a special grant from the Nanjing Drum Tower Hospital in Nanjing, China
Correspondence to: Qin Huang, MD, PhD, Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA 02132, United States. qinhuang0122@gmail.com
Telephone: +1-857-2035020 Fax: +1-857-2035623
Received: August 27, 2012
Revised: October 25, 2012
Accepted: November 6, 2012
Published online: December 28, 2012
Processing time: 156 Days and 13.4 Hours
Abstract

Carcinoma of the gastroesophageal junction (GEJ) is defined as carcinoma that crosses the GEJ line, irrespective of where the tumor epicenter is located. This group of cancer is rare but controversial. Based on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries, this cancer is believed to arise from Barrett’s esophagus (BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology, clinicopathology, and molecular pathobiology in relation to BE. As such, the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma (EA). This mandate has been challenged recently by the data from several studies carried out mainly in Chinese patients. The emerging evidence derived from those studies suggests: (1) both BE and EA are uncommon in the Chinese population; (2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer, not those of EA; (3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients’ prognosis effectively; and (4) prognostic factors of GEJ cancer in Chinese are similar, but not identical, to those of EA. In conclusion, the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from EA. Further investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.

Keywords: Esophagus; Stomach; Cancer; Gastroesophageal junction; Staging; Barrett’s esophagus