The relevance of the Siewert classification in the era of multimodal therapy for adenocarcinoma of the gastro-oesophageal junction

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), 202-207. (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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Contributors

Author: Timothy J. Underwood

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