The relevance of the Siewert classification in the era of multimodal therapy for adenocarcinoma of the gastro-oesophageal junction
The relevance of the Siewert classification in the era of multimodal therapy for adenocarcinoma of the gastro-oesophageal junction
Methods: A prospective database was reviewed for all patients who underwent resection from 2005 to 2011 and analysed with regard to Siewert classification determined from the pathological specimen, treatment and clincopathological outcomes.
Results: Two hundred and sixteen patients underwent oesophagogastric resection: 133 for type I, 51 for type II and 33 for type III tumours. 135 Patients (62.5%) received neoadjuvant chemotherapy with no difference between groups. There were no significant differences in age, sex, pT stage, pN stage, pM stage, ASA, or inpatient complications between patients with adenocarcinoma based on their Siewert classification. There was a significant increase in maximum tumour diameter (P?=?0.023), perineural invasion (P?=?0.021) and vascular invasion (P?=?0.020), associated with more distal tumours (Type III?>?Type II?>?Type I). Median overall survival was significantly shorter for more distal tumours (Type I: 4.96 years vs. Type II: 3.3 years vs. Type III: 2.64 years; P?=?0.04). The surgical approach did not influence survival.Conclusion:
In the era of multi-modal treatment pathological Siewert tumour type is of prognostic value, as patients with Type III disease are likely to have larger and more aggressive tumours that lead to worse outcomes.
siewert classification, oesophageal cancer, oesophagectomy, surgical approach
202-207
Curtis, Nathan J.
42545b06-6545-41a9-bdbc-a239549758d7
Noble, Fergus
4f14574c-28f2-4e04-bd95-f53c7649e1fa
Bailey, Ian S.
073dd11d-7b7d-43e0-a412-be0b2feb0620
Kelly, Jamie J.
0110cc21-7ece-4ab1-92ae-46b3e7d5c650
Byrne, James P.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Underwood, Timothy J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
March 2014
Curtis, Nathan J.
42545b06-6545-41a9-bdbc-a239549758d7
Noble, Fergus
4f14574c-28f2-4e04-bd95-f53c7649e1fa
Bailey, Ian S.
073dd11d-7b7d-43e0-a412-be0b2feb0620
Kelly, Jamie J.
0110cc21-7ece-4ab1-92ae-46b3e7d5c650
Byrne, James P.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Underwood, Timothy J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Curtis, Nathan J., Noble, Fergus, Bailey, Ian S., Kelly, Jamie J., Byrne, James P. and Underwood, Timothy J.
(2014)
The relevance of the Siewert classification in the era of multimodal therapy for adenocarcinoma of the gastro-oesophageal junction.
Journal of Surgical Oncology, 109 (3), .
(doi:10.1002/jso.23484).
(PMID:24243140)
Abstract
Methods: A prospective database was reviewed for all patients who underwent resection from 2005 to 2011 and analysed with regard to Siewert classification determined from the pathological specimen, treatment and clincopathological outcomes.
Results: Two hundred and sixteen patients underwent oesophagogastric resection: 133 for type I, 51 for type II and 33 for type III tumours. 135 Patients (62.5%) received neoadjuvant chemotherapy with no difference between groups. There were no significant differences in age, sex, pT stage, pN stage, pM stage, ASA, or inpatient complications between patients with adenocarcinoma based on their Siewert classification. There was a significant increase in maximum tumour diameter (P?=?0.023), perineural invasion (P?=?0.021) and vascular invasion (P?=?0.020), associated with more distal tumours (Type III?>?Type II?>?Type I). Median overall survival was significantly shorter for more distal tumours (Type I: 4.96 years vs. Type II: 3.3 years vs. Type III: 2.64 years; P?=?0.04). The surgical approach did not influence survival.Conclusion:
In the era of multi-modal treatment pathological Siewert tumour type is of prognostic value, as patients with Type III disease are likely to have larger and more aggressive tumours that lead to worse outcomes.
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e-pub ahead of print date: 14 November 2013
Published date: March 2014
Keywords:
siewert classification, oesophageal cancer, oesophagectomy, surgical approach
Organisations:
Cancer Sciences
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Local EPrints ID: 360952
URI: http://eprints.soton.ac.uk/id/eprint/360952
ISSN: 0022-4790
PURE UUID: 2717f42a-4886-4148-806f-46c92b5a03a8
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Date deposited: 09 Jan 2014 13:16
Last modified: 15 Mar 2024 03:17
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Author:
Nathan J. Curtis
Author:
Fergus Noble
Author:
Ian S. Bailey
Author:
Jamie J. Kelly
Author:
James P. Byrne
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