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The relevance of the Siewert classification in the era of multimodal therapy for adenocarcinoma of the gastro‐oesophageal junction
Author(s) -
Curtis Nathan J.,
Noble Fergus,
Bailey Ian S.,
Kelly Jamie J.,
Byrne James P.,
Underwood Timothy J.
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23484
Subject(s) - medicine , adenocarcinoma , pathological , stage (stratigraphy) , perineural invasion , chemotherapy , gastroenterology , neoadjuvant therapy , multimodal therapy , clinical significance , cohort , cancer , breast cancer , paleontology , biology
The Siewert classification has been used to plan treatment for tumours of the gastro‐oesophageal junction since its proposal in the 1980s. The purpose of this study was to assess its continued relevance by evaluating whether there were differences in the biology and clinical characteristics of adenocarcinomas by Siewert type, in a contemporary cohort of patients, in whom the majority had received neoadjuvant chemotherapy. Methods A prospective database was reviewed for all patients who underwent resection from 2005 to 2011 and analysed with regard to Siewert classification determined from the pathological specimen, treatment and clincopathological outcomes. Results Two hundred and sixteen patients underwent oesophagogastric resection: 133 for type I, 51 for type II and 33 for type III tumours. 135 Patients (62.5%) received neoadjuvant chemotherapy with no difference between groups. There were no significant differences in age, sex, pT stage, pN stage, pM stage, ASA, or inpatient complications between patients with adenocarcinoma based on their Siewert classification. There was a significant increase in maximum tumour diameter ( P = 0.023), perineural invasion ( P = 0.021) and vascular invasion ( P = 0.020), associated with more distal tumours (Type III > Type II > Type I). Median overall survival was significantly shorter for more distal tumours (Type I: 4.96 years vs. Type II: 3.3 years vs. Type III: 2.64 years; P = 0.04). The surgical approach did not influence survival. Conclusion In the era of multi‐modal treatment pathological Siewert tumour type is of prognostic value, as patients with Type III disease are likely to have larger and more aggressive tumours that lead to worse outcomes. J. Surg. Oncol . 2014;109:202–207. © 2013 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.