Assessment of risk factors of lymph node metastasis and follow-up of Siewert Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction / 国际外科学杂志

ABSTRACT

Objective:To explore the risk factors of lymph node metastasis and prognosis in Siewert Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction (AEG) patients.Methods:A total of 134 patients who underwent surgical operation between June 2013 and December 2019 at the Beijing Friendship Hospital, Capital Medical University were retrospectively reviewed, including 112 males and 22 females, with a male to female ratio of 5.5∶1 and an average age of 62.1(27-82 years old). The primary outcomes were lymph node metastasis risk and 3-years overall survival. The secondary outcomes were the rate and pattern of lymph node metastasis. Follow-up methods mainly include outpatient and telephone. During the follow-up period, the patient needs to receive physical examination, laboratory examinations, chest and abdominal CT scan and gastroscopy to evaluate the status of disease. The patients were followed up until January 2020. Chi-square test or Fisher test was used for the comparison between count data group, and rank sum test was used for the comparison between grade data group. Stepwise Logistic regression was used for multivariate analysis, and COX regression risk model was used for survival analysis.Results:Multivariate analysis revealed that the parameters infiltration depth ( OR=4.341, 95% CI 2.498-7.545, P=0.000), gross type ( OR=3.626, 95% CI 1.425-9.228, P=0.007) and intravascular cancer embolus ( OR=2.888, 95% CI 1.106-7.544, P=0.030) correlated with lymph node metastasis. For all patients, the lymph nodes No. 1, 2, 3, 4, 7, 11 indicated higher lymph node metastatic rate in the abdominal cavity. However, No.5 and No. 6 indicated different tendency, which was higher in Siewert Ⅲ AEG and lower in Siewert Ⅱ AEG patients. Mediastinal lymph node metastasis of Siewert Ⅱ AEG mainly occurred in No. 110 and No. 111 cases corresponding to 7.1 and 3.0%, respectively, compared with those noted in Siewert Ⅲ AEG patients. The 3-year overall survival analysis revealed that lymph node metastasis (82.1% vs 46.1%, P=0.046) and chemotherapy (60.6% vs 39.4%, P=0.007) exhibited significant differences. Conclusions:The infiltration depth, gross type and intravascular cancer embolus are independent risk factors of lymph node metastasis. In addition, patients with lymph node metastasis exhibite worse long-term prognosis. The data indicate that perioperative chemotherapy could improve the prognosis of AEG patients.