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Adenosquamous Carcinoma of the Esophagus and Esophagogastric Junction—an Analysis of Clinical Manifestations and Surgical Outcomes
Yung-Han Sun*1,2, Chih-Cheng Hsieh2, Chun-Hsien Chen3, Shih-Wei Lin3
1Department of Surgery, Taipei-Veterans General Hospital, Taipei, Taiwan; 2Graduate Institute of Business and Management, Chang Gung University, Taoyuan, Taiwan; 3Department of Information Management, Chang Gung University, Taoyuan, Taiwan
Background: Adenosquamous carcinoma (ASC) is a rare cell type of cancer, not only in the esophagus, but in the stomach. Its characteristics and surgical outcomes are still unclear. The aim of this study is to investigate the clinical presentation, the surgical outcome and the prognostic factors influencing survival.
Patients and Methods: Between 1981 and 2011, 27 patients who were diagnosed with ASC of esophagus and esophagogastric junction and received operation with curative intent were retrospectively analyzed. The medical records of these patients were systematically reviewed. The clinicopathological parameters were evaluated including age, gender, main symptoms at presentation, tumor location, maximum size, pathological T&N status and survival. Tumor staging was classified according to the 7th edition of AJCC cancer staging system. The Kaplan-Meier method and the log rank test were used to calculate and compare the overall survival. The Cox proportional hazards were employed to identify independent prognostic factors.
Results: There were 24 males and 3 females with a mean age of 66.1 years (range 37-80 years). There were 13 smokers and 13 patients with alcohol habit. No one had betel nuts chewing history. The main symptoms were swallowing difficulty in 17 patients and body weight loss in 10 patients and the average symptoms duration was 3.4 months before admission for operation. Only one patient (1/27, 3.7%) could be diagnosed as ASC by preoperative endoscopic biopsy. Due to tumor location and preoperative biopsy result, 20 patients were considered as esophageal cancer that received esophagectomy with reconstruction, the other 7 patients were categorized as gastric cardia cancer that received total gastrectomy with Roux-en-Y esophagojejunostomy. There was one surgical mortality. The median follow-up period was 32 months (range 0.5-12 months). The 3-year and 5-year overall survival rate were 50% and 33%, respectively. Univariate analysis showed that pathological T status, tumor maximum size and perineural invasion were prognostic factors for overall survival. Multivariate analysis showed that only tumor maximum size and perineural invasion were independent prognostic factors, shown in Table 1.
Conclusions: ASC of esophagus and esophagogastric junction was rare cell type of cancer and difficult to categorize. It is difficult to diagnosis pre-operatively. Surgical resection is the primary treatment and the prognosis of ASC was better than that of squamous cell carcinoma of the esophagus. Tumor maximum size and perineural invasion were independent prognostic factors for overall survival in multivariate analysis. Table 1. Multivariate analysis of prognostic factors influencing overall survival after surgical resection | Variable | Relative Risk (95% CI) | p value | | Tumor maximum size | | 1.138-1.869 | 0.003 | | Perineural invasion | Absent | 1 | 0.005 | | Present | 1.744-22.622 | |
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