SSAT - Gastroesophageal Junction Tumors Clinically Staged cT2: Accuracy of Staging Results and Therapeutic Consequences At Two Academic Centers

Gastroesophageal Junction Tumors Clinically Staged cT2: Accuracy of Staging Results and Therapeutic Consequences At Two Academic Centers
Daniel Vallbohmer^*¹, Susanne Blank², Leila Sisic², Sebastian Kraus¹, Andreas Krieg¹, Wolfram T. Knoefel¹, Markus W. Buchler², Katja Ott²
¹Department of Surgery, University of Dusseldorf, Dusseldorf, Germany; ²Department of Surgery, University of Heidelberg, Heidelberg, Germany

Background: Multimodality treatment options in locally advanced (cT3/4) tumors of the gastroesophageal junction (AEG) have been established over the last years. However, the therapeutic approach in patients with clinically staged cT2 tumors remains highly controversial. At this, the most important determinant is the accuracy of clinical staging and final histopathological report. Therefore, we aimed to evaluate the association of clinical and histopathological staging in patients with cT2 tumors in respect of possible therapeutic consequences.
Patients and Methods: Between 2001 and 2011 71 patients with AEG were clinically staged cT2 (cN0=48; cN+=23) based on endoscopy, endosonography and computed tomography. All study patients underwent surgical resection (R0 resection rate: 96%). Statistical analyses were performed using an established database.
Results: Twenty-four (34%) patients had an AEG I, 43 (61%) an AEG II and 4 (5%) patients an AEG III. A primary tumor resection was performed in 59 (83%) patients while 12 (17%) patients initially received a neoadjuvant therapy. There was a significant correlation between cN+-category and neoadjuvant therapy (10/23 with cN+ versus 2/48 with cN0-Kategorie; p<0.001). Primary resected patients showed the following pT-/pN-categories: pT1 22%, pT2 59%, pT3 19%, pN0 39% and pN+ 56%, whereas clinical and histopathological pN-category consisted in 55% of the patients. Neoadjuvant treated patients showed the following pT-/pN-categories:
ypT0 25 %, ypT1 25 %, ypT2 50%, ypN0 50% and ypN+ 42%. The overall survival of primary resected patients compared patients undergoing neoadjuvant therapy was not significantly different. In addition, no significant survival benefit was detected in patients with cN+-status receiving neoadjuvant therapy.
Conclusions: The accuracy of clinical staging in patients with cT2 tumors of the gastroesophageal junction is poor. As in primary resected patients over- and understaging balance each other, pre-therapeutic over-staging occurs in about 50% of the patients. A neoadjuvant therapy can not generally recommended in this patient group.

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