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Latin American population with adenocarcinoma of the esophagogastric junction: A 9-year follow up
Background
Esophagogastric junction (EGJ) adenocarcinoma represents 27% of gastric tumors with an increasing incidence in Western countries. Additionally, up to 80% of EGJ tumors are diagnosed in advanced stages of disease, therefore the prognosis is usually poor, with a 5-year overall survival rate of less than 30%. It is known that EGJ tumors are an entity with its own epidemiological characteristics, biological behavior, and prognosis, without evidence to support optimal management. The aim of this study was to describe clinicopathological features, treatment, and outcome of Latin American patients with EGJ adenocarcinoma treated at the National Cancer Institute.
Methods
Retrospective, observational study. Included patients diagnosed with EGJ adenocarcinoma, treated at the National Cancer Institute between 2003 and 2020. Statistical analysis required: X2 and t test, Kaplan Meier, Log Rank and Cox Regression. Statistical significance differences were assessed when p was bilaterally <0.05.
Results
A total of 174 patients were included in the analysis. The 82%(n=143) of cases were male with a median age at diagnosis of 58 (18-90) years old. Comorbidities included type-2. Diabetes (21%), systemic arterial hypertension (20%), besides, almost half of patients had history of smoking and alcohol consumption (45% and 34%, respectively). Median history of disease pretreatment of 4 months. Most prevalent symptoms included weight loss (85%, n= 148), dysphagia (83%, n= 144), and epigastric pain (47%, n= 6). Patients included were subdivided in 2 groups 1) metastatic (n=80= and non-metastatic (n=94). Among non-metastatic patients, the 80% (n=75) received neoadjuvant treatment, among them, 66% (n=62) were treated with chemoradiotherapy. Out of the total patients who received neoadjuvant treatment, the 82% (n=60) completed treatment and 58% (n=34) of them received surgery, among them the 59% (n=20) was R0 surgical margins. An OS analysis was conducted comparing treatment modalities in these patients, for the patients who received chemoradiotherapy and surgery the median-OS was 54 months versus 16 months for those without complete neoadjuvant treatment (p=<0.001; HR 0.32, 95%CI 0.17-0.62). Otherwise for metastatic disease, the 66% (n=53) received first-line chemotherapy treatment, the remaining 34%(n=27) did not accept treatment or were not candidates so best supportive care (BSC) was decided. At OS analysis, patients treated with chemotherapy had a median-OS of 11 months versus 4 months for patients without treatment (p=<0.001; HR 0.18, 95%CI 0.09-0.36). Besides, comparing clinical stage, median-OS was 20 and 8 months for Non-metastatic and metastatic patients (p=<0.001; HR 2.57, 95%CI 1.75-3.79).
Conclusions
EGJ Adenocarcinoma is a disease with a poor prognosis, associated with a high prevalence of gastroesophageal reflux, obesity, and dietary changes. There is no standard of treatment in this entity however, perioperative chemoradiotherapy has shown benefit in the overall survival of patients with locally advanced disease. As for metastatic disease, chemotherapy remains the best treatment option. Further clinical trials involving new therapy options for these patients are necessary to improve outcome and prognosis.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
