Adenocarcinoma of the esophagogastric junction and its background mucosal pathology: A comparative analysis according to Siewert classification in a Japanese cohort

Abstract

Adenocarcinoma of the esophagogastric junction (AEG) has heterogeneous carcinogenic process due to its location straddling the esophagogastric junction. We assessed background mucosal pathology and its correlation with clinicopathological features of each Siewert type of AEG. Clinicopathological and immunohistochemical analyses of 103 AEGs and 58 gastric cancers (GCs) were conducted. Background mucosal features were evaluated according to the updated Sydney System. Siewert classification divided 103 AEGs into three type I, 75 type II, and 25 type III tumors, respectively. Two type I, 9 type II AEGs, and none of type III AEGs were Barrett‐related and were excluded from further analysis. Background mucosa of type III AEGs more frequently showed moderate to marked degree of atrophy and intestinal metaplasia than those of type II AEGs and was very similar to those of GCs. Among type II AEGs, tumors with atrophic background were significantly associated with higher patient age and intestinal‐type histology. Type II AEGs with nonatrophic background, but not those with atrophic background, showed more frequent mismatch repair deficiency, TP53 overexpression, and less frequent intestinal phenotypic markers expression than type III AEG or GC. Type II AEGs with atrophic background involved suprapancreatic nodes more frequently than those without. We demonstrated that chronic atrophic gastritis was a major precancerous condition of AEG in the Japanese population, especially Siewert type III which had background mucosal pathology similar to that of GC. Type II AEGs with and without atrophic background showed some clinicopathological differences, and these observations might represent heterogeneous carcinogenic process within type II AEGs.

Endoscopic and Pathological Characteristics of <b><i>Helicobacter pylori</i></b> Infection-Negative Early Gastric Cancer

“…The cardiac gland type, which appears to originate in the cardiac gland, is one type of esophageal gastric cancer. It is a noteworthy type of HPINGC because the incidence of adenocarcinoma in the esophagogastric junction has significantly increased in both Western and Asian countries with higher rates of obesity or prevalence of gastroesophageal reflux disease [38][39][40]. To distinguish from Barrett carcinoma, we have excluded the cases with Barrett epithelium endoscopically and clinicopathology.…”

Circulating Levels of L1-cell Adhesion Molecule as a Serum Biomarker for Early Detection of Gastric Cancer and Esophagogastric Junction Adenocarcinoma

“…Helicobacter pylori infection, genetic and environmental factors are high risk factors for GC [28,29]. Gastroesophageal refluxes disease (GERD), as well as increasing body weight and obesity, were strongly associated with an increased risk of EJA [4], but associations between H pylori and EJA are unclear [4,29]. The development of GC includes inflammation, gland atrophy, intestinal metaplasia and dysplasia, and it is considered that the carcinogenic process of EJA is very similar to that of GC patients [4,30].…”

“…Gastroesophageal refluxes disease (GERD), as well as increasing body weight and obesity, were strongly associated with an increased risk of EJA [4], but associations between H pylori and EJA are unclear [4,29]. The development of GC includes inflammation, gland atrophy, intestinal metaplasia and dysplasia, and it is considered that the carcinogenic process of EJA is very similar to that of GC patients [4,30]. Relevant statistical results showed that the 5-year survival rate of domestic GC patients after surgery was 30.0-50.0%.…”

“…On the other hand, in the worldwide, the incidence of esophagogastric junctional cancer has increased rapidly in recent decades [1,3]. Some studies have shown that the incidence of esophagogastric junctional cancer in China is higher than that in Western countries [1,3,4]. The vast majority of gastric cancers and esophagogastric junctional cancers are adenocarcinomas [5,6].…”

Overexpression of Epidermal Growth Factor Receptor (EGFR) in Esophageal Squamous Cell Carcinoma and Its Correlation with Clinicopathological Characteristics in Central Uganda

“…Esophageal Squamous Cell Carcinoma (ESCC) is the malignant tumor in the squamous epithelium that lines the normal esophagus [1]. Esophageal carcinoma (EC) is the eighth most common cancer and the sixth leading cause of cancer related deaths worldwide [2].…”