Staging of adenocarcinoma of the esophagogastric junction: Comparison of AJCC 6th and 7th gastric and 7th esophageal staging systems

Hyoung Il Kim, Jae Ho Cheong, Ki Jun Song, Ji Yeong An, Woo Jin Hyung, Sung Hoon Noh, Choong Bai Kim

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Adenocarcinoma of esophagogastric junction (EGJ) is currently staged by the esophageal staging criteria according to the American Joint Committee on Cancer (AJCC) staging system, 7th edition. We compared the performance of 6th gastric (G6), 7th gastric (G7), and 7th esophageal (E7) staging systems. Methods: A total of 202 curatively resected adenocarcinomas of EGJ were analyzed. Patient outcomes were assessed according to G6, G7, and E7 staging. Tumor invasion to the subserosal or serosa layer was regarded as invasion to the adventitia for E7 staging. Performance was measured based on monotonicity (decreasing survival with increasing stage), distinctiveness (survival difference between different stages), and homogeneity (homogenous survival in the same stage). Results: Each staging system was monotonous except for T1-2N0 lesions of E7. This was related to the introduction of histologic grade in E7 staging. Distinctiveness in each staging system was variable. As for the homogeneity, patients whose disease was staged as Ib (E7) exhibited different survival when reassessed by G6 and G7; again, this was related to histologic grading. Patients with IIIb (G7) and IIIc (E7) disease had different survival when reassessed by G6 staging, reflecting the poorer survival of patients with more than 15 lymph node metastases. Conclusions: Staging of EGJ cancer based on the current AJCC, 7th edition, criteria of esophageal cancer staging has several limitations. We recommend considering modifications of the following in future updates of the staging system: accurate anatomical definition of tumor depth, removal of histologic grade from staging parameters, and classification of more than 15 lymph node metastases as a highly advanced stage.

Original languageEnglish
Pages (from-to)2713-2720
Number of pages8
JournalAnnals of surgical oncology
Volume20
Issue number8
DOIs
Publication statusPublished - 2013 Aug 1

Fingerprint

Esophagogastric Junction
Stomach
Adenocarcinoma
Survival
Neoplasms
Neoplasm Staging
Lymph Nodes
Neoplasm Metastasis
Serous Membrane
Adventitia
Esophageal Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Kim, Hyoung Il ; Cheong, Jae Ho ; Song, Ki Jun ; An, Ji Yeong ; Hyung, Woo Jin ; Noh, Sung Hoon ; Kim, Choong Bai. / Staging of adenocarcinoma of the esophagogastric junction : Comparison of AJCC 6th and 7th gastric and 7th esophageal staging systems. In: Annals of surgical oncology. 2013 ; Vol. 20, No. 8. pp. 2713-2720.
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title = "Staging of adenocarcinoma of the esophagogastric junction: Comparison of AJCC 6th and 7th gastric and 7th esophageal staging systems",
abstract = "Background: Adenocarcinoma of esophagogastric junction (EGJ) is currently staged by the esophageal staging criteria according to the American Joint Committee on Cancer (AJCC) staging system, 7th edition. We compared the performance of 6th gastric (G6), 7th gastric (G7), and 7th esophageal (E7) staging systems. Methods: A total of 202 curatively resected adenocarcinomas of EGJ were analyzed. Patient outcomes were assessed according to G6, G7, and E7 staging. Tumor invasion to the subserosal or serosa layer was regarded as invasion to the adventitia for E7 staging. Performance was measured based on monotonicity (decreasing survival with increasing stage), distinctiveness (survival difference between different stages), and homogeneity (homogenous survival in the same stage). Results: Each staging system was monotonous except for T1-2N0 lesions of E7. This was related to the introduction of histologic grade in E7 staging. Distinctiveness in each staging system was variable. As for the homogeneity, patients whose disease was staged as Ib (E7) exhibited different survival when reassessed by G6 and G7; again, this was related to histologic grading. Patients with IIIb (G7) and IIIc (E7) disease had different survival when reassessed by G6 staging, reflecting the poorer survival of patients with more than 15 lymph node metastases. Conclusions: Staging of EGJ cancer based on the current AJCC, 7th edition, criteria of esophageal cancer staging has several limitations. We recommend considering modifications of the following in future updates of the staging system: accurate anatomical definition of tumor depth, removal of histologic grade from staging parameters, and classification of more than 15 lymph node metastases as a highly advanced stage.",
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Staging of adenocarcinoma of the esophagogastric junction : Comparison of AJCC 6th and 7th gastric and 7th esophageal staging systems. / Kim, Hyoung Il; Cheong, Jae Ho; Song, Ki Jun; An, Ji Yeong; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong Bai.

In: Annals of surgical oncology, Vol. 20, No. 8, 01.08.2013, p. 2713-2720.

Research output: Contribution to journalArticle

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T1 - Staging of adenocarcinoma of the esophagogastric junction

T2 - Comparison of AJCC 6th and 7th gastric and 7th esophageal staging systems

AU - Kim, Hyoung Il

AU - Cheong, Jae Ho

AU - Song, Ki Jun

AU - An, Ji Yeong

AU - Hyung, Woo Jin

AU - Noh, Sung Hoon

AU - Kim, Choong Bai

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Background: Adenocarcinoma of esophagogastric junction (EGJ) is currently staged by the esophageal staging criteria according to the American Joint Committee on Cancer (AJCC) staging system, 7th edition. We compared the performance of 6th gastric (G6), 7th gastric (G7), and 7th esophageal (E7) staging systems. Methods: A total of 202 curatively resected adenocarcinomas of EGJ were analyzed. Patient outcomes were assessed according to G6, G7, and E7 staging. Tumor invasion to the subserosal or serosa layer was regarded as invasion to the adventitia for E7 staging. Performance was measured based on monotonicity (decreasing survival with increasing stage), distinctiveness (survival difference between different stages), and homogeneity (homogenous survival in the same stage). Results: Each staging system was monotonous except for T1-2N0 lesions of E7. This was related to the introduction of histologic grade in E7 staging. Distinctiveness in each staging system was variable. As for the homogeneity, patients whose disease was staged as Ib (E7) exhibited different survival when reassessed by G6 and G7; again, this was related to histologic grading. Patients with IIIb (G7) and IIIc (E7) disease had different survival when reassessed by G6 staging, reflecting the poorer survival of patients with more than 15 lymph node metastases. Conclusions: Staging of EGJ cancer based on the current AJCC, 7th edition, criteria of esophageal cancer staging has several limitations. We recommend considering modifications of the following in future updates of the staging system: accurate anatomical definition of tumor depth, removal of histologic grade from staging parameters, and classification of more than 15 lymph node metastases as a highly advanced stage.

AB - Background: Adenocarcinoma of esophagogastric junction (EGJ) is currently staged by the esophageal staging criteria according to the American Joint Committee on Cancer (AJCC) staging system, 7th edition. We compared the performance of 6th gastric (G6), 7th gastric (G7), and 7th esophageal (E7) staging systems. Methods: A total of 202 curatively resected adenocarcinomas of EGJ were analyzed. Patient outcomes were assessed according to G6, G7, and E7 staging. Tumor invasion to the subserosal or serosa layer was regarded as invasion to the adventitia for E7 staging. Performance was measured based on monotonicity (decreasing survival with increasing stage), distinctiveness (survival difference between different stages), and homogeneity (homogenous survival in the same stage). Results: Each staging system was monotonous except for T1-2N0 lesions of E7. This was related to the introduction of histologic grade in E7 staging. Distinctiveness in each staging system was variable. As for the homogeneity, patients whose disease was staged as Ib (E7) exhibited different survival when reassessed by G6 and G7; again, this was related to histologic grading. Patients with IIIb (G7) and IIIc (E7) disease had different survival when reassessed by G6 staging, reflecting the poorer survival of patients with more than 15 lymph node metastases. Conclusions: Staging of EGJ cancer based on the current AJCC, 7th edition, criteria of esophageal cancer staging has several limitations. We recommend considering modifications of the following in future updates of the staging system: accurate anatomical definition of tumor depth, removal of histologic grade from staging parameters, and classification of more than 15 lymph node metastases as a highly advanced stage.

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