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10.1245/s10434-006-9216-4
Annals of Surgical Oncology 14:1439-1448 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Treatment of the Adenocarcinoma of the Esophagogastric Junction at a Single Institution in Mexico

Luis F. Oñate-Ocaña, MD1, Gonzalo Milán-Revollo, MD1, Vincenzo Aiello-Crocifoglio, MD1, José F. Carrillo, MD1, Dolores Gallardo-Rincón, MD2, Rocío Brom-Valladares, MD, MPH3, Roberto Herrera-Goepfert, MD4 and Alfonso Dueñas-González, MD, PhD5

1 Clínica de Neoplasias Gástricas, Gastroenterology Department, Surgery Division, Instituto Nacional de Cancerología, México D.F., México
2 Medical Oncology Department, Internal Medicine Division, Instituto Nacional de Cancerología, México D.F., México
3 Tomography, Ultrasound and Magnetic Resonance Department, Instituto Nacional de Cancerología, México D.F., México
4 Pathology Department, Instituto Nacional de Cancerología, México D.F., México
5 Unidad de Investigación Biomédica en Cancer, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Instituto Nacional de Cancerología, México D.F., México

Correspondence: Address correspondence and reprint requests to: Luis F. Oñate-Ocaña, MD. Gastroenterology Department, Instituto Nacional de Cancerología, San Fernando 22, México D.F., 14080, México; E-mail: lfonate{at}gmail.com

Background: Adenocarcinoma of the esophagogastric junction (EGJ) is rapidly increasing in the west. Our aim is to define the prognostic factors and treatment of EGJ carcinoma in Mexico, particularly the location after the Siewert’s classification.

Methods: A retrospective cohort of patients suffering from EGJ adenocarcinoma treated from 1987 to 2000. The Kaplan-Meier and the Cox’s models were used to define prognostic factors.

Results: Two hundred and thirty-four patients were included, 90 females and 144 males. Surgical resection was possible in 68 cases only (29%). Significant prognostic factors were tumor node metastasis (TNM) stage [stages I–II: risk ratio (RR) is 1; stage III RR is 1.3, 95% confidence interval (CI) 0.75–2.4; stage IV RR, 2.04, 95% CI 1.1–3.7], gender (male RR = 1.47, 95% CI 1.05–2.05), metastatic lymph node ratio (no resection: RR = 1; ratio 0.2–1 RR=0.67, 95% CI 0.39–1.14; ratio 0–0.19 RR = 0.42, 95% CI 0.23–0.76) and seralbumin (3 mg/dL or less RR = 2.05 95% CI 1.3–3.2; 3.1–3.4 mg/dL RR = 1.9 95% CI 1.2–3.03; 3.5–3.8 mg/dL RR = 1.3 95% CI 0.8–1.9; 3.9 mg/dL or more: RR = 1) (model P = 0.0001).

Conclusions: EGJ adenocarcinoma is a highly lethal neoplasia and the location after the Siewert’ classification is not a prognostic factor. In Mexico, TNM clinical stage, serum albumin, gender, surgical resection and metastatic lymph node ratio are significant prognostic factors. Curative treatment is infrequent but radical resection is associated to longer survival. Consequently, the management must consider quality of life and surgical morbidity.

Key Words: prognostic factors • adenocarcinoma • esophageal cancer • gastric cancer • esophagogastric junction






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