# The impact of histological subtype on postoperative recurrence pattern and timing in locally advanced esophagogastric junction cancer

## TL;DR

This study shows that adenocarcinoma and squamous cell carcinoma of the esophagogastric junction behave differently after surgery, affecting recurrence patterns and timing.

## Contribution

The study reveals distinct recurrence behaviors between histological subtypes of EGJ cancer, offering insights for personalized treatment strategies.

## Key findings

- Adenocarcinoma showed significantly worse non-lymphogenous recurrence-free survival compared to squamous cell carcinoma.
- Adenocarcinoma had a significantly longer time from surgery to recurrence than squamous cell carcinoma.
- Histological subtype was a significant predictor of non-lymphogenous recurrence in multivariate analysis.

## Abstract

The differences in tumor behavior between adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the esophagogastric junction (EGJ) have yet to be well investigated. The purpose of this study was to gain insights that can contribute to tailored treatments and follow-up strategies by analyzing the correlation between histological subtypes and oncological outcomes.

A retrospective analysis was used to determine the characteristics of the histological subtypes of EGJ cancer by comparing the appearance of postoperative recurrence. A total of 102 consecutive patients with pathological stage IIA to IVA EGJ cancer, who underwent R0 surgery in our department from 2004 to 2020, were enrolled. The recurrence pattern, timing, survival, and potential prognostic factors were compared.

After a median follow-up time of 70.1 months, the AC group demonstrated comparable lymph node failure-free survival (P = 0.291) and significantly worse non-lymphogenous recurrence-free survival (P = 0.035) than did the SCC group. A significantly longer period from surgery to recurrence was also observed in the AC group (P = 0.029). Multivariate analysis indicated that histological subtype (P = 0.015, 95% CI 1.24–7.28) was significantly correlated with the incidence of non-lymphogenous recurrence.

The pattern and timing of postoperative recurrence were significantly different between the histological subtypes of EGJ cancer. Compared with EGJ SCC, EGJ AC may have a greater tendency toward non-lymphogenous progression and a greater propensity for longer surgery-to-recurrence periods.