Zhang J, Liu H, Yu H, Xu WX. Development of a novel staging classification for Siewert II adenocarcinoma of the esophagogastric junction after neoadjuvant chemotherapy. World J Gastrointest Oncol 2024; 16(6): 2541-2554 [DOI: 10.4251/wjgo.v16.i6.2541]
Corresponding Author of This Article
Jian Zhang, MD, Chief, Chief Doctor, Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 1367 West Wenyi Road, Yuhang District, Hangzhou 310003, Zhejiang Province, China. ljzju001@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Clinical and Translational Research
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. Jun 15, 2024; 16(6): 2541-2554 Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2541
Table 1 Clinicopathological characteristics of Siewert type II adenocarcinoma of the esophagogastric junction underwent radical gastrectomy with neoadjuvant chemotherapy
Characteristics
n (%)/mean ± SD
Age, (yr)
< 65
468 (64.6)
≥ 65
257 (35.4)
Sex
Male
623 (85.9)
Female
102 (14.1)
Marital status
Married
502 (69.2)
Divorced or separated
79 (10.9)
Single (never married)
91 (12.6)
Widowed
30 (4.1)
Others
23 (3.2)
Race
White
647 (89.2)
Others
78 (10.8)
Year of operation
2004-2009
230 (31.7)
2010-2015
495 (68.3)
Type of surgery
Subtotal gastrectomy
418 (57.7)
Total gastrectomy
156 (21.5)
Unknown
151 (20.8)
Tumor size
< 50 mm
387 (53.4)
≥ 50 mm
200 (27.6)
Unknown
138 (19.0)
The number of examined lymph nodes
17.4 ± 10.9
yp T stage
T1
82 (11.3)
T2
108 (14.9)
T3
441 (60.8)
T4
94 (13.0)
yp N stage
N0
218 (30.1)
N1
223 (30.8)
N2
186 (25.7)
N3
98 (13.5)
Grade
Well differentiated
35 (4.8)
Moderate differentiated
253 (34.9)
Low differentiated
400 (55.2)
The tumor grade cannot be identified
37 (5.1)
Adjuvant chemotherapy
No
530 (73.1)
Yes
139 (19.2)
Unknown
56 (7.7)
Table 2 Univariate and multivariate analysis of overall survival for Siewert type II adenocarcinoma of the esophagogastric junction underwent radical gastrectomy with neoadjuvant chemotherapy
Univariate analysis
Multivariate analysis
HR
95%CI
P value
HR
95%CI
P value
Age
< 65 yr
1
≥ 65 yr
1.11
0.93-1.33
0.259
Sex
Male
1
1
Female
0.81
0.62-1.06
0.120
0.74
0.57-0.98
0.035
Marital status
Married
1
1
Divorced or separated
1.38
1.05-1.8
0.019
1.51
1.15-1.99
0.003
Single (never married)
1.11
0.85-1.46
0.435
1.07
0.81-1.4
0.642
Widowed
1.40
0.91-2.15
0.130
1.34
0.86-2.08
0.198
Others
0.77
0.43-1.37
0.368
0.74
0.41-1.31
0.302
Race
White
1
1
Others
0.81
0.6-1.1
0.173
0.8
0.59-1.08
0.148
Year of diagnosis
2004-2009
1
2010-2015
1.01
0.84-1.22
0.910
Type of surgery
Subtotal gastrectomy
1
Total gastrectomy
1.04
0.83-1.3
0.762
Tumor size
< 50 mm
1
≥ 50 mm
1.08
0.88-1.32
0.477
The number of examined lymph nodes
1
0.99-1
0.379
yp T stage
T1
1
1
T2
1.42
0.96-2.1
0.082
1.25
0.84-1.87
0.265
T3
1.89
1.36-2.63
< 0.001
1.43
1.01-2.02
0.043
T4a
2.66
1.82-3.88
< 0.001
1.85
1.24-2.75
0.003
yp N stage
N0
1
1
N1
1.40
1.1-1.78
0.006
1.37
1.07-1.76
0.012
N2
1.90
1.49-2.42
< 0.001
1.84
1.42-2.38
< 0.001
N3
3.13
2.37-4.12
< 0.001
3.11
2.31-4.18
< 0.001
Grade
Well differentiated
1
Moderate differentiated
0.87
0.56-1.35
0.539
Low differentiated
1.31
0.86-2
0.211
Gx
1.01
0.58-1.77
0.976
Adjuvant chemotherapy
No
1
1
Yes
0.80
0.63-1.02
0.067
0.67
0.52-0.85
0.001
Table 3 Univariate and multivariate analysis of disease-specific survival for Siewert type II adenocarcinoma of the esophagogastric junction underwent radical gastrectomy with neoadjuvant chemotherapy
Univariate analysis
Multivariate analysis
HR
95%CI
P value
HR
95%CI
P value
Age
< 65 yr old
1
≥ 65 yr old
1.01
0.83-1.24
0.895
Sex
Male
1
1
Female
0.75
0.56-1.01
0.060
0.75
0.55-1.01
0.056
Marital status
Married
1
Divorced or separated
1.23
0.9-1.67
0.197
Single (never married)
1.23
0.93-1.63
0.150
Widowed
1.18
0.71-1.96
0.516
Others
0.84
0.46-1.54
0.579
Race
White
1
1
Others
0.78
0.55-1.09
0.142
0.72
0.51-1.01
0.054
Year of diagnosis
2004-2009
1
2010-2015
0.96
0.78-1.18
0.699
Type of surgery
Subtotal gastrectomy
1
Total gastrectomy
1
0.78-1.28
0.985
Tumor size
< 50 mm
1
≥ 50 mm
1.08
0.86-1.35
0.504
The number of examined lymph nodes
1
0.99-1.01
0.516
yp T stage
T1
1
1
T2
1.44
0.9-2.3
0.125
1.25
0.78-2.01
0.347
T3
2.29
1.55-3.38
< 0.001
1.69
1.13-2.54
0.010
T4a
3.19
2.06-4.94
< 0.001
2.18
1.38-3.44
0.001
yp N stage
N0
1
1
N1
1.56
1.19-2.05
0.001
1.43
1.08-1.88
0.012
N2
2.22
1.7-2.92
< 0.001
1.93
1.45-2.56
< 0.001
N3
3.7
2.73-5.02
< 0.001
3.17
2.31-4.35
< 0.001
Grade
Well differentiated
1
Moderate differentiated
0.93
0.56-1.55
0.795
Low differentiated
1.53
0.93-2.49
0.091
Gx
1.11
0.58-2.1
0.759
Adjuvant chemotherapy
No
1
Yes
0.88
0.68-1.12
0.301
Table 4 Model evaluation
Models
Harrell's C-index
AIC
Log likelihood
P value
OS
Novel nomogram
0.635 (0.609-0.662)
-2923.6
5875.2
Ref.
8th AJCC EC ypTNM staging system
0.610 (0.583-0.636)
-2940.6
5889.1
0.004
8th AJCC GC ypTNM staging system
0.593 (0.568-0.619)
-2948.4
5900.7
< 0.001
DSS
Novel nomogram
0.635 (0.607-0.664)
-2451.9
4927.7
Ref.
8th AJCC EC ypTNM staging system
0.627 (0.600-0.655)
-2458.9
4925.8
0.218
8th AJCC GC ypTNM staging system
0.609 (0.582-0.636)
-2467.2
4938.4
< 0.001
Citation: Zhang J, Liu H, Yu H, Xu WX. Development of a novel staging classification for Siewert II adenocarcinoma of the esophagogastric junction after neoadjuvant chemotherapy. World J Gastrointest Oncol 2024; 16(6): 2541-2554