The length of negative proximal resection margin does not significantly influence on the prognosis of Siewert type II adenocarcinoma of esophagogastric junction with or without neoadjuvant chemotherapy

TL;DR

This study finds that the length of the proximal resection margin does not affect survival in Siewert type II esophagogastric junction cancer patients, regardless of chemotherapy use.

Contribution

The study is the first to show that PRM length does not impact prognosis in Siewert type II adenocarcinoma patients with or without chemotherapy.

Findings

Positive PRM status is linked to worse recurrence-free survival.

PRM length does not affect survival outcomes in patients with negative PRM.

No significant survival differences were found based on PRM length in either chemotherapy or surgery-only groups.

Abstract

Optimal length of proximal resection margin (PRM) for locally advanced Siewert type II adenocarcinoma of esophagogastric junction (AEG) remained undetermined. Especially, the relationship between PRM length after neoadjuvant chemotherapy (NAC) and survival were seldom reported.

A total of 108 consecutive locally advanced Siewert type II AEG patients were enrolled. The clinicopathological characteristics, PRM length and survival outcomes were collected. Cox proportional hazard model was used to compare the hazard rates of survival and recurrence between patients with length above and below the cut-off value. Univariable and multivariable analyses were performed to analysis association between PRM length and prognosis.

The mean PRM length was 13mm (range: 1–45 mm). PRM status was independent factor for recurrence-free survival (RFS) (HR 3.177, 95%CI 1.098-9.193, p = 0.033). 4 patients (3.7%) had positive PRM on histological pathology, and they suffered shorter RFS than patients with negative PRM (16.0 ± 4.3 months vs 60.1 ± 3.9 months, p = 0.002). In 104 patients with negative PRM, NAC was administered to 53 patients (51.0%). The length of PRM was not associated with survival outcomes in NAC group and surgery alone (SA) group, respectively. The hazard rates of survival and recurrence did not differ between the patients with length of PRM above and below the cut-off value (p>0.05). No statistically significant differences in survival outcomes were observed between patients with different PRM lengths in either the NAC group or the SA group. Similarly, no statistically significant differences in survival outcomes were found across different PRM lengths, no matter which treatment strategy was chosen.

A positive status of PRM appears to be associated with adverse survival outcomes of patients with locally advanced Siewert type II AEG after surgery. However, for patients with negative status, the length of the PRM does not influence survival, regardless of whether they undergo surgical resection alone or NAC followed by surgery.

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