Guo S, Liu FF, Yuan L, Ma WQ, Er LM, Zhao Q. Subclassification scheme for adenocarcinomas of the esophagogastric junction and prognostic analysis based on clinicopathological features. World J Gastrointest Oncol 2025; 17(4): 103455 [DOI: 10.4251/wjgo.v17.i4.103455]
Corresponding Author of This Article
Qun Zhao, Chief Physician, MD, Department of Gastrointestinal Surgery, Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Changan District, Shijiazhuang 050011, Hebei Province, China. zhaoqun@hebmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Apr 15, 2025; 17(4): 103455 Published online Apr 15, 2025. doi: 10.4251/wjgo.v17.i4.103455
Subclassification scheme for adenocarcinomas of the esophagogastric junction and prognostic analysis based on clinicopathological features
Shuo Guo, Fang-Fang Liu, Li Yuan, Wen-Qian Ma, Li-Mian Er, Qun Zhao
Shuo Guo, Li Yuan, Wen-Qian Ma, Li-Mian Er, Department of Endoscopy, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Fang-Fang Liu, Department of Nutrition, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Qun Zhao, Department of Gastrointestinal Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Author contributions: Guo S and Zhao Q designed the research study; Guo S, Liu FF, Yuan L, Ma WQ, Er LM collected the data; Guo S and Er LM performed the research; Guo S and Liu FF analyzed the data and wrote the manuscript; Zhao Q reviewed the manuscript; All authors have read and approve the final manuscript.
Supported by the Medical Science Research Project of Hebei, No. 20211323.
Institutional review board statement: This study was approved by the Ethics Committee of the Fourth Hospital of Hebei Medical University (Approval No. 2024KY198).
Informed consent statement: This study involves a review of existing medical records and does not require direct interaction with patients. Therefore, it is not possible to obtain informed consent from individual patients. Based on ethical guidelines, a waiver of informed consent has been granted by the Fourth Hospital of Hebei Medical University, as the research poses minimal risk to patient privacy and confidentiality.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qun Zhao, Chief Physician, MD, Department of Gastrointestinal Surgery, Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Changan District, Shijiazhuang 050011, Hebei Province, China. zhaoqun@hebmu.edu.cn
Received: November 21, 2024 Revised: January 11, 2025 Accepted: January 21, 2025 Published online: April 15, 2025 Processing time: 124 Days and 8.2 Hours
Abstract
BACKGROUND
Adenocarcinoma of the esophagogastric junction (AEG) has distinct malignant features compared with other esophageal and gastric cancers. Its management is controversial and largely influenced by tumor location and esophageal involvement. Hence, understanding the clinicopathological characteristics and prognosis of AEG is essential for optimizing treatment strategies.
AIM
To evaluate the prognosis and clinicopathological features of patients with AEG, providing insights for management strategies.
METHODS
This retrospective study analyzed cases with AEG admitted between January 2016 and December 2017. Patients meeting the inclusion criteria were categorized into three groups: Type E [tumors whose center was located within 5 cm above the esophagogastric junction (EGJ)]; Type Eg (tumors whose center was situated within 2 cm below the EGJ), with a 2-cm esophageal invasion; Type Ge (tumors whose center was situated within 2 cm below the EGJ, with an esophageal invasion of < 2 cm, based on tumor location and esophageal involvement. Then, clinicopathological characteristics and survival outcomes of the groups were compared to evaluate the predictive value of the American Joint Committee on Cancer/International Alliance against Cancer 8th edition gastric cancer and esophageal adenocarcinoma staging systems. Statistical analysis included survival analysis and Cox regression to assess prognostic factors.
RESULTS
Totally, 153 patients with AEG were included (median follow up: 41.1 months; 22, 31, and 100 patients from type E, Eg, and Ge, respectively), with significant differences in maximum tumor length, esophageal involvement length, tumor type, pathology, differentiation, depth of invasion, and lymph node metastasis between the groups (P < 0.05). Lymph node metastasis rates at stations 1, 2, 3, and 7 were lower in type E than in Eg and Ge (P < 0.05). Survival rates for type E (45.5%) were significantly lower than those for Eg (48.4%) and Ge (73.0%) (P = 0.001). Type E tumors, vascular infiltration, T3-T4 invasion depth, and lymph node metastasis, were identified as independent prognostic factors (P < 0.05). The gastric cancer staging system outperformed the esophageal adenocarcinoma system for type Ge tumors.
CONCLUSION
Clinicopathological characteristics and prognoses varied between the AEG groups, with type E demonstrating distinct features. The gastric cancer staging system more accurately predicted type Ge AEG prognosis, guiding clinical decision-making.
Core Tip: This study introduces a novel subclassification for adenocarcinoma of the esophagogastric junction (AEG) based on the tumor center location and esophageal invasion. By distinguishing between types E, Eg, and Ge AEGs, the study identified significant differences in clinicopathological features and prognoses. Type E tumors were associated with poorer outcomes, and the American Joint Committee on Cancer/International Alliance against Cancer gastric cancer staging system more accurately predicted the prognosis of type Ge AEGs than did the esophageal adenocarcinoma system. This subclassification therefore improves prognosis prediction and may guide tailored clinical management for patients with AEG.
