Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction Journal Article
| Authors: | Barbour, A. P.; Rizk, N. P.; Gerdes, H.; Bains, M. S.; Rusch, V. W.; Brennan, M. F.; Coit, D. G. |
| Article Title: | Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction |
| Abstract: | Background: Endoscopic ultrasound (EUS) is the most accurate locoregional staging tool for gastroesophageal junction (GEJ) adenocarcinoma, and it may allow pretreatment risk stratification. The purpose of this study was to compare preoperative EUS staging with postoperative pathologic staging and to assess the ability of EUS to predict survival after resection for GEJ adenocarcinoma. Study Design: Patients with GEJ adenocarcinoma, who had preoperative staging with EUS followed by resection, were identified from a prospectively maintained database. Patients receiving neoadjuvant therapy were excluded. EUS stage was compared with pathologic stage. Survival analyses were performed in patients who underwent complete gross resection. Results: From 1985 through 2003, 209 patients underwent preoperative EUS followed by surgery without neoadjuvant therapy for GEJ adenocarcinoma. EUS correlated with pathologic T stage in 128 of 209 (61%) patients and with pathologic nodal stage in 154 of 206 (75%) patients. EUS accurately stratified patients into "early" (T0-2 N0) or "advanced" (T3-4 or N1) disease categories in 173 (83%) patients. Curative (R0) resection was performed in 184 patients: EUS "early" (n = 84) and "advanced" (n = 122) stages were associated with R0 rates of 100% and 82%, respectively (p = 0.001). EUS "early" versus "advanced" stage was highly predictive of outcomes (p < 0.0001). The 5-year disease-specific survival for EUS "early" patients was 65% compared with 34% for EUS "advanced" stage. Conclusions: EUS accurately predicts pathologic stage. In addition, EUS is predictive of outcomes after complete gross resection without neoadjuvant treatment for GEJ adenocarcinoma and identifies a high-risk population that might benefit from preoperative therapy. © 2007 American College of Surgeons. |
| Keywords: | adult; cancer survival; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; major clinical study; postoperative period; adjuvant therapy; cancer patient; preoperative care; cancer staging; outcome assessment; lymph node metastasis; cancer diagnosis; neoplasm staging; prospective study; adenocarcinoma; disease association; ultrasound; digestive system cancer; preoperative period; predictive value of tests; predictor variable; high risk population; esophageal adenocarcinoma; stomach neoplasms; esophageal neoplasms; endosonography; digestive tract endoscopy; esophagogastric junction; gastroesophageal adenocarcinoma |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 205 |
| Issue: | 4 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2007-10-01 |
| Start Page: | 593 |
| End Page: | 601 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2007.05.010 |
| PUBMED: | 17903735 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 20" - "Export Date: 17 November 2011" - "CODEN: JACSE" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work