Epidemiology of Gastroesophageal Junction Adenocarcinoma in Korea

The incidence of gastroesophageal junction adenocarcinoma (GEJAC) in Western countries has increased in recent decades, in addition to a rise in the incidence of esophageal adenocarcinoma (EAC). Gastroesophageal reflux disease (GERD), obesity, smoking, alcohol consumption, and low Helicobacter pylori (HP) infection rate have been nominated as risk factors for such cancers. Among these risk factors, the increased prevalence of GERD and obesity and the decreased prevalence of HP infection are of special interest owing to the currently increasing prevalence of GEJAC in Western countries. Although similar trends in the prevalence of GERD, obesity, and HP infection are observed in Asian countries after a time lag from Western countries, it is still uncertain if the prevalence of GEJAC in Asian countries is increasing, especially in Korea. The incidence of GERD in Korea is currently increasing; it was below 3% in the 1990s. The incidence of obesity in the Korean population is increasing owing to the adoption of westernized lifestyles, including food preferences, and the HP infection rate in Korea is known to be decreasing. Therefore, based on logical extrapolation of observations of Western countries, the incidence of GEJAC will increase in Korea. However, the proportion of GEJAC among other upper gastrointestinal malignancies in Korea appears to be currently unchanged compared with that in the 1990s. Presently, there is a lack of epidemiologic studies on this issue in this region; therefore, more studies are needed to clarify the characteristics of these tumors and to improve clinical outcomes for patients with these tumors.

Efficacy and prognosis of different surgical approach in siewert Ⅱ and Ⅲ gastroesophageal junction adenocarcinoma / 中国综合临床

Objective To investigate the surgical approach of Siewert Ⅱ and Ⅲ gastroesophageal junction adenocarcinoma.Methods A total of 148 cases with Siewert Ⅱ,Ⅲ type patients were prospectively studied.The patients were divided into two groups,including transthoracic approach group (58 cases) and transabdominal approach group(90 cases).The results of surgery were compared.Patients were followed up for 2 years and survival rate were compared.Results In transthoracic approach group and transabdominal approach group,operative time ((329.5 ± 84.3) min vs.(202.4± 84.5) min,t =15.431,P ＜ 0.001),the positive rate margin stump (8.62％ vs.1.11％,x2 =5.763,P =0.012),pleural effusion (13.79％ vs.2.22％,x2 =10.462,P ＜0.001) and pulmonary infection rate (15.52％ vs 1.11％,x2 =12.574,P＜ 0.001) were significantly higher than transabdominal approach group,and number of lymph node dissection ((16.7 ± 4.3) vs.(22.6± 5.5),t =6.321,P =0.004) was significantly less than transabdominal approach group.In incidence of blood loss,tumor diameter,anastomotic leakage (or bleeding) and discharge time,there was no significant difference (P ＞0.05).One-year survival rate of transthoracic approach group was 73.24％,and 2-year survival rate was 53.43％.Oneyear survival rate of transabdominal approach group was 78.42％,and 2-year survival rate was 57.51％.Survival rate of two groups showed no significant difference (P =0.453,0.311).Conclusion Transabdominal surgical approach in Siewert Ⅱ,Ⅲ patients is better than transthoracic approach,can better carry out abdominal lymph node dissection,does not destroy the integrity of the chest,and avoid the occurrence of related complications.

Advances in molecular-targeted therapies for gastric cancer and gastroesophageal junction adenocarcinoma / 中国肿瘤临床

The prognosis of advanced gastric cancer and gastroesophageal junction (GEJ) adenocarcinoma is poor. Although che-motherapy prolongs patient survival and improves quality of life to a greater extent best supportive care compared to, the median over-survival of patients with advanced gastric cancer is limited to approximately 7-10 months. With remarkable progress in the understand-ing of molecular mechanisms, molecular-targeted agents have been developed and evaluated in international randomized phaseⅢclini-cal trials. These agents may change the treatment mode of this disease. A ToGA study initially demonstrated that the trastuzumab, the monoclonal antibody of HER-2, as a molecular-targeted agent, in combination with chemotherapy, can prolong the overall survival of patients to 13.8 months. Several agents targeting angiogenesis, c-Met, PARP, and immunotherapy are currently subjected to clinical tri-als. This review summarizes the current status of molecular-targeted therapies for gastric cancer and GEJ adenocarcinoma.

Current situation and progress in the comprehensive treatment of locally advanced gastroesophageal junction adenocarcinoma / 中国肿瘤临床

Based on special biological characteristics and prognosis, the incidence of gastroesophageal junction adenocarcinoma (GEJA) has rapidly increased over recent years, and its diagnosis and treatment remain controversial. Compared with simple surgery, neo-adjuvant and adjuvant therapies can improve the survival of patients with locally advanced GEJA. Under neo-adjuvant therapy, neo-adjuvant chemoradiation is superior to neo-adjuvant chemotherapy alone for improving the resectability, maintaining loco-regional control, and improving the quality of life of the patient. The combination of this therapy with targeted drugs may further increase the ef-ficacy of GEJA. Most data on GEJA-treated patients were obtained from randomized clinical studies on esophageal cancer or gastric cancer. Thus, prospective randomized controlled studies with a large sample size should be performed to optimize the strategy of neo-adjuvant and adjuvant therapies, and further improve the treatment outcome. In this article, studies on the comprehensive treatment of GEJA were reviewed.