P0389 - Prognostic Factors of Esophagogastric Adenocarcinoma in a Single-Center Veteran Population

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Qin Huang, MD, PhD

Beth Israel Deaconess Medical Center
Boston, MA

Qin Huang, MD, PhD¹, Kevin Huang, MD², Edward Lew, MD, MPH³, Yuqing Cheng, MD, MSc⁴, Horst C. Weber, MD³
¹Beth Israel Deaconess Medical Center, Boston, MA; ²Boston Medical Center, Boston, MA; ³VA Boston Healthcare System, Boston, MA; ⁴Nanjing Medical University, Changzhou, Jiangsu, China

Introduction: Esophagogastric adenocarcinoma (EGA) includes esophageal (EA), gastroesophageal junctional (GEJA), and distal gastric (DGA) adenocarcinomas. Prognostic significance of clinicopathologic factors in those tumors remain obscure, especially for GEJA that has been inconsistently classified and staged. The aim of this study was therefore to determine prognostic features of EGA in three geographic tumor groups in a large single center cohort.

Methods: This is a retrospective study of patients with proven EGA treated within the VA Boston Healthcare System over a 20-year period. Patient charts were reviewed to classify EGA tumors into EA, GEJA, and DGA subgroups, based on the tumor epicenter location information. All relevant clinical-pathological data were extracted from charts and tabulated using student t-test, Chi square and Fisher exact test. Histopathologic features of each EGA case with available histologic slides were determined by a single gastrointestinal pathologist. Overall survival (OS) was estimated with the Kaplan-Meier methods.

Results: 347 eligible patients with a median age of 70 years (range: 48-94) were identified. All patients were male and 97.1% were White. Based on tumor epicenter location, EGAs were divided into EA (over 2 cm above the GEJ; N=63, 18.1%), GEJA (within 2 cm above and 3 cm below the GEJ; N=231, 66.6%), and DGA (over 3 cm below the GEJ; N=53, 15.3%). The median overall survival (OS) was the longest in EA (62.9 months), compared to GEJA (33.4), and DGA (38.1) (P < 0.001; Figure). Significant risk factors for OS (Table) included tumor location (P = 0.018), size (P < 0.001), differentiation (P < 0.001), adenocarcinoma subtype (P < 0.001), TNM stages (P < 0.001). Independent risk factors for OS included low-grade papillary adenocarcinoma (P < 0.05), mixed adenocarcinoma (P < 0.05), adenosquamous carcinoma (P < 0.05), and TNM stages (P < 0.05). Based on tumor differentiation, EGA was further divided into low-risk (common well-moderately differentiated tubular and low-grade papillary adenocarcinomas) and high-risk (uncommon adenocarcinoma subtypes) subgroups, whereby median OS was significantly longer in the low-risk (83 months) than in the high-risk (10 months) subgroups (P < 0.001; data not shown).

Discussion: EGA is heterogeneous with significantly better OS in EA than in GEJA or DGA and could be stratified into low- and high-risk subgroups with significantly different outcomes.

Figure: Figure: Overall survival is shown for three groups. The Kaplan-Meier method was used with a log rank test to estimate OS. Survivors were censored.
OS was significantly longer in EA than in GEJA and DGA groups (P = 0.005), but not different between GEJA and DGA groups (P = 0.604).

Characteristic	Total Number (%)	Mean Overall Survival (months, mean + Standard Error)	P value
Number	347 (100)	70.0
Age (yrs)			0.094
< 59	43 (12.4)	58.7 ± 11.8
60-69	118 (34.0)	41.3 ± 5.7
70-79	121 (34.9)	35.3 ± 4.5
>80	65 (18.7)	29.7 ± 19.2
Tumor location			0.018
Distal Esophagus ( > 2 cm above GEJ)	63 (18.1)	62.9 ± 9.9
GEJ (2 cm above/3 cm below GEJ	231 (66.6)	33.4 ± 3.3
Distal stomach ( >3 cm below GEJ)	53 (15.3)	38.1 ± 7.5
Tumor size (cm)			< 0.001
< 0.9	34 (9.8)	84.7 ± 13.9
1.0-2.9	77 (22.2)	57.2 ± 6.8
3.0-3.9	158 (45.5)	50.5 ± 10.5
>4.0	158 (45.5)	20.6 ± 2.9
unknown	37 (10.7).001	22.4 ± 5.4
Tumor differentiation			< 0.001
Well-moderate differentiation	141 (40.6)	61.5 ± 5.8
Poor differentiation	206 (59.4)	24.1 ± 18.1
Tumor invasion depth			< 0.001
T1	87 (25.1)	85.5 ± 8.0
T2	50 (14.4)	41.4 ± 6.4
T3-4	138 (39.8)	25.5 ± 3.8
unknown	72 (20.7)	9.6 ± 1.7
Nodal metastasis			< 0.001
N0	126 (36.3)	72.6 ±8.5
N1-3	142 (40.9)	23.2 ±3.8
unknown	79 (22.8)	13.2 ±5.7
Distant metastasis			< 0.001
Absent	110 (31.7)	73.5 ± 7.0
Present	152 (43.8)	14.7 ± 1.5
unknown	74 (21.3)	34.7 ± 5.9

Table: Table: Prognostic value of clinicopathologic variables in overall survival of patients with esophagogastric adenocarcinoma. GEJ denotes Gastroesophageal Junction,

Disclosures:

Qin Huang indicated no relevant financial relationships.

Kevin Huang indicated no relevant financial relationships.

Edward Lew indicated no relevant financial relationships.

Yuqing Cheng indicated no relevant financial relationships.

Horst Weber indicated no relevant financial relationships.

Qin Huang, MD, PhD¹, Kevin Huang, MD², Edward Lew, MD, MPH³, Yuqing Cheng, MD, MSc⁴, Horst C. Weber, MD³. P0389 - Prognostic Factors of Esophagogastric Adenocarcinoma in a Single-Center Veteran Population, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.