Is Barrett's Metaplasia the Source of Adenocarcinomas of the Cardia?

Clark, Geoffrey W.B.; Smyrk, Thomas C.; Burdiles, Patricio; Hoeft, S.; Peters, Jeffrey H.; Kiyabu, Milton; Hinder, Ronald A.; Bremner, Cedric G.; DeMeester, Tom R.

doi:10.1001/archsurg.1994.01420300051007

Cited by 277 publications

(135 citation statements)

References 25 publications

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“…EGJ-type tumors appear to be not related to this pathway, and they expressed p53 protein. These characteristics are similar to those of cardia adenocarcinoma in Western patients, but in our series, Barrett's metaplasia was detected in only two patients (3.8%), and the frequency of Barrett's metaplasia is much less in Japanese than in Western people (13%-42%) [18][19][20]. In the present study of small Siewert type II junctional cancers, the number of tumors that did not cross the EGJ (bEGJ-type) was larger than the number that did (EGJ-type).…”

Section: Discussionsupporting

confidence: 79%

Mucin phenotypic expression and background mucosa of esophagogastric junctional adenocarcinoma

et al. 2004

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Section: Discussionsupporting

confidence: 79%

Mucin phenotypic expression and background mucosa of esophagogastric junctional adenocarcinoma

et al. 2004

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“…Several previous reports have described a greater tendency of C-Ca than D-Ca towards deeper wall penetration, lymph node metastasis and poor prognosis, indicating that C-Ca may be a more aggressive tumour than D-Ca (Kalish et al, 1984;Wang et al, 1986;MacDonald and MacDonald, 1987;Hamilton et al, 1988;Clark et al, 1994;Ohno et al, 1995;Siewert and Stein, 1996;Kajiyama et al, 1997;Pinheiro et al, 1999;Tajima et al, 2001a). In this study, C-Ca was associated with a significantly higher prevalence of LVI than D-Ca.…”

Section: Discussionsupporting

confidence: 58%

“…It is associated with reflux symptoms, predominance in white males and a greater frequency of differentiated-type tumours as compared with adenocarcinoma of the distal stomach (D-Ca). It has also been described to show a greater tendency towards deeper wall penetration, lymph node metastasis, and a poor prognosis (Kalish et al, 1984;Wang et al, 1986;MacDonald and MacDonald, 1987;Hamilton et al, 1988;Clark et al, 1994;Ohno et al, 1995;Siewert and Stein, 1996;Kajiyama et al, 1997;Pinheiro et al, 1999;Tajima et al, 2001a). We have previously reported that early-stage of C-Ca is associated with higher frequency of gastric phenotypic marker expression and lower frequency of intestinal metaplasia of the surrounding mucosa as compared with early-stage of D-Ca (Tajima et al, 2001a).…”

mentioning

confidence: 76%

Differences in the histological findings, phenotypic marker expressions and genetic alterations between adenocarcinoma of the gastric cardia and distal stomach

et al. 2007

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Adenocarcinoma of the gastric cardia (C-Ca) is possibly a specific subtype of gastric carcinoma. The purpose of this study was to clarify the differences in the clinicopathological characteristics between C-Ca and adenocarcinoma of the distal stomach (D-Ca), and also the differences in the expressions of gastric and intestinal phenotypic markers and genetic alterations between the two. The clinicopathological findings in 72 cases with C-Ca were examined and compared with those in 170 cases with D-Ca. The phenotypic marker expressions examined were those of human gastric mucin (HGM), MUC6, MUC2 and CD10. Furthermore, the presence of mutations in the APC, K-ras and p53 genes and the microsatellite instability status of the tumour were also determined. C-Ca was associated with a significantly higher incidence of differentiated-type tumours and lymphatic vessel invasion (LVI) as compared with D-Ca (72.2 vs 48.2%, P ¼ 0.0006 and 72.2 vs 55.3%, P ¼ 0.0232, respectively). Oesophageal invasion by the tumour beyond the oesophago-gastric junction (OGJ) was found in 56.9% of cases with C-Ca; LVI in the area of oesophageal invasion was demonstrated in 61% of these cases. Also, LVI was found more frequently in cases of C-Ca with oesophageal invasion than in those without oesophageal invasion (82.9 vs 58.1%, P ¼ 0.0197). The incidence of undifferentiated-type tumours was significantly higher in cases with advanced-stage C-Ca than in those with early-stage C-Ca (5 vs 36.5%, P ¼ 0.0076). A significantly greater frequency of HGM expression in early-stage C-Ca and significantly lower frequency of MUC2 expression in advanced-stage C-Ca was observed as compared with the corresponding values in cases of D-Ca (78.9 vs 52.2%, P ¼ 0.0402 and 51.5 vs 84.6%, P ¼ 0.0247, respectively). Mutation of the APC gene was found in only one of all cases of C-Ca, and the frequency of mutation of the APC gene was significantly lower in cases of C-Ca than in those of D-Ca (2.4 vs 20.0%, P ¼ 0.0108). The observations in this study suggest that C-Ca is a more aggressive tumour than D-Ca. The differences in biological behavior between C-Ca and D-Ca may result from the different histological findings in the wall of the OGJ and the different genetic pathways involved in the carcinogenesis.

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“…adenocarcinoma of oesophago-gastric junction (Antonioli and Goldman, 1982;Meyers et al, 1987;Hesketh et al, 1989;Powell and McConkey, 1990;Blot et al, 1991;Pera et al, 1993;McKinney et al, 1995). Similarities in terms of histopathology and epidemiological trends have been identified (Kalish et al, 1984;Wang et al, 1986;MacDonald and MacDonald, 1987;Powell and McConkey, 1992;Heidl et al, 1993;Siewert and Stein, 1998) and have led some observers to consider the two cancers as one disease with similar aetiologies (Clark et al, 1994).…”

mentioning

confidence: 98%

The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction

et al. 2002

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Knowledge of the pattern of recurrence of surgically treated cases of adenocarcinoma of the oesophago-gastric junction is important both for better understanding of their biological nature and for future strategic planning of therapy. The aim of this study is to demonstrate and compare the pattern of dissemination and recurrence in patients with Type I and Type II adenocarcinoma of oesophago-gastric junction. A prospective audit of the clinico-pathological features of patients who had undergone surgery with curative intent for adenocarcinoma of oesophago-gastric junction between 1991 and 1996 was undertaken. Patients were followed up by regular clinical examination. Clinical evaluation was supported by ultrasound, computerised tomography, radio-isotope bone scan, endoscopy and laparotomy each with biopsy and histology where appropriate. One hundred and sixty-nine patients with oesophago-gastric junction tumours (94 Type I and 75 Type II) have been followed up for a median of 75.3 (57 -133) months. One hundred and three patients developed proven recurrent disease. The median time to recurrence was 23.3 (14.2 -32.4) months for Type I and 20.5 (11.6 -29.4) for Type II cancers. The most frequent type of recurrence was haematogenous (56% of Type I recurrences and 54% of Type II) of which 56% were detected within 1 year of surgery. The most frequent sites were to liver (27%), bone (18%) brain (11%) and lung (11%). Local recurrence occurred in 33% of Type I cancer and 29% of Type II recurrences. Nodal recurrence occurred in 18 and 25% of Type I and Type II cancer recurrences, most frequently to coeliac or porta hepatis nodes (64%). Only 7% of Type I and 15% of Type II cancer recurrences were by peritoneal dissemination. Type I and Type II adenocarcinoma of the oesophago-gastric junction have a predominantly early, haematogenous pattern of recurrence. There is a need to better identify the group of patients with small metastases at the time of diagnosis who are destined to develop recurrent disease in order that they may be spared surgery and those with micro metastases in order that they can be offered multi-modality therapy including early post operative or neo-adjuvant chemotherapy.

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Is Barrett's Metaplasia the Source of Adenocarcinomas of the Cardia?

Cited by 277 publications

References 25 publications

Mucin phenotypic expression and background mucosa of esophagogastric junctional adenocarcinoma

Mucin phenotypic expression and background mucosa of esophagogastric junctional adenocarcinoma

Differences in the histological findings, phenotypic marker expressions and genetic alterations between adenocarcinoma of the gastric cardia and distal stomach

The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction

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