A team from Newcastle, England, investigated the pattern of dissemination and recurrence in patients with Type I and Type II adenocarcinoma of the esophago-gastric junction.
They undertook a prospective audit of the clinico-pathological features of patients who had undergone surgery with curative intent for adenocarcinoma of the esophago-gastric junction between 1991 and 1996.
A total of 169 patients were followed up by regular clinical examination (94 Type I and 75 Type II tumors).
Ultrasound, computerized tomography, radioisotope bone scan, endoscopy, and laparotomy, each with biopsy and histology, supported this, where appropriate.
The patients were followed up for a median of 75 months.
Some 103 patients developed proven recurrent disease. The median time to recurrence was 23 months for Type I and 21 for Type II cancers.
The most frequent type of recurrence was hematogenous (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%).
The researchers found that local recurrence occurred in 33% of Type I cancer and 29% of Type II recurrences.
| Hematogenous recurrences were most frequent.
| British Journal of Cancer |
Nodal recurrence occurred in 18% and 25% of Type I and Type II cancer recurrences, respectively, most frequently to celiac or porta hepatis nodes (64%).
Only 7% of Type I and 15% of Type II cancer recurrences were by peritoneal dissemination.
Author S. A. Raimes, of the Royal Victoria Infirmary in Newcastle, said on behalf of the group, "Type I and Type II adenocarcinoma of the esophago-gastric junction have a predominantly early, hematogenous 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.
"Those with micro metastases should also be identified in order that they can be offered multi-modality therapy, including early post operative or neo-adjuvant chemotherapy," it was concluded.