HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bryan A. Whitson Michael A. Maddaus Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Whitson, B. A. Articles by Maddaus, M. A. Search for Related Content PubMed PubMed Citation Articles by Whitson, B. A. Articles by Maddaus, M. A. Related Collections Esophagus - cancer

J Thorac Cardiovasc Surg 2010;139:43-48
© 2010 The American Association for Thoracic Surgery

General Thoracic Surgery

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

^a Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
^b Biostatistics Core, University of Minnesota Cancer Center, Minneapolis, Minn
^c Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minn

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

Received for publication July 3, 2008; revisions received March 26, 2009; accepted for publication April 12, 2009.

^_* Address for reprints: Michael A. Maddaus, MD, University of Minnesota Department of Surgery, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455. (Email: madda001{at}umn.edu).

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.