Survival of patients with distal esophageal and gastric cardia tumors: A population-based analysis of gastroesophageal junction carcinomas

Whitson, Bryan A.; Groth, Shawn S.; Li, Zhongze; Kratzke, Robert A.; Maddaus, Michael A.

doi:10.1016/j.jtcvs.2009.04.011

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 1 , Pages 43-48, January 2010

Survival of patients with distal esophageal and gastric cardia tumors: A population-based analysis of gastroesophageal junction carcinomas

Presented at the American Society of Clinical Oncology 2008 Annual Meeting, Chicago, Ill, May 30-June 3, 2008.

Bryan A. Whitson, MD, PhD
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Shawn S. Groth, MD
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Zhongze Li, MS
- Biostatistics Core, University of Minnesota Cancer Center, Minneapolis, Minn
Robert A. Kratzke, MD
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minn
Michael A. Maddaus, MD
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
- Address for reprints: Michael A. Maddaus, MD, University of Minnesota Department of Surgery, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455.

Received 3 July 2008; received in revised form 26 March 2009; accepted 12 April 2009. published online 15 June 2009.

Objective

Distal esophageal tumors and gastric cardia tumors, although only physically separated by centimeters, have different staging systems and are usually treated differently. We hypothesized that gastroesophageal junction adenocarcinomas (eg, gastric cardia and distal esophageal tumors) were not distinct entities and had similar survival.

Methods

Using the Surveillance, Epidemiology, and End Results database (1988–2005), we identified patients with adenocarcinomas of the distal esophagus (n = 1474) and gastric cardia (n = 192). We performed an unadjusted survival analysis using the Kaplan–Meier method, and we used a Cox proportional hazards regression model to adjust for potential confounding covariates. A 2-sided significance level was used for all statistical testing.

Results

Even after adjusting for potential confounding covariates (location, stage, race, cancer-directed surgery, and radiation therapy), we found no significant difference between distal esophageal and gastric cardia tumors with regard to overall (hazard ratio, 1.18; 95% confidence interval, 0.99–1.41) and cancer-specific (hazard ratio, 1.09; 95% confidence interval, 0.90–1.31) survival. Both cancer-directed surgery (hazard ratio, 0.45; 95% confidence interval, 0.37–0.54) and radiation therapy (hazard ratio, 0.63; 95% confidence interval, 0.55–0.71) had a beneficial influence on survival.

Conclusion

Through a large, population-based analysis of gastric cardia and distal esophageal adenocarcinomas, we found that patients with gastroesophageal junction adenocarcinomas have similar survival rates. Cancer-directed surgery was beneficial. Adenocarcinomas of the gastroesophageal junction are not distinct entities delineated by anatomic boundaries and as such should be managed by one skilled in both esophageal and gastric resections.

CTSNet classification: 7

Abbreviations and Acronyms: AJCC, American Joint Committee on Cancer, DE, distal esophageal, GC, gastric cardia, GEJ, gastroesophageal junction, SEER, Surveillance, Epidemiology, and End Results