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J Gastrointest Surg (2015) 19:12161222
DOI 10.1007/s11605-015-2852-x
Yung-Han Sun1,2 & Shih-Wei Lin3 & Chun-Hsien Chen3 &
Wen-Yih Liang4 & Chih-Cheng Hsieh1,5
Received: 9 January 2015 /Accepted: 4 May 2015 /Published online: 13 May 2015 # 2015 The Society for Surgery of the Alimentary Tract
Abstract
Background/Aims The aim of this study is to understand the clinicopathological manifestations, treatment, and prognostic factors of adenosquamous carcinoma (ASC) of the esophagus and esophagogastric junction, a rare malignancy.
Methods From 1981 to 2011, 26 out of 4704 patients (23 males, 3 females; mean age: 65.8 years) with ASC of the esophagus and esophagogastric junction who received surgical resection were analyzed.
Results Only one (4.2 %) patient was diagnosed with ASC by preoperative endoscopic biopsy. Three patients received Ivor-Lewis operation with intrathoracic esophagogastrostomy, seven received gastrectomies, and the other 16 underwent transthoracic esophagectomies. Median follow-up time was 30.6 months (interquartile range, 17.995.1 months). At study end, there were 12(46.2 %) patients with tumor relapse, all within 3 years postoperatively. The 5-year disease-free survival (DFS) rate was 46.2 %. Tumor length and no postoperative adjuvant treatment were the independent prognostic factors for DFS. The 5-year overall survival (OS) rate was 30.8 %. On multivariate analysis, the resection type, tumor length, and perineural invasion were independent prognostic factors for OS.
Conclusion ASC is a rare cell type of the esophagus and esophagogastric junction that is easily misdiagnosed at endoscopic biopsy. OS rate was no worse than that reported for squamous cell carcinoma (SCC). Tumor length was the independent prognostic factor for both DFS and OS.
Keywords Adenosquamous carcinoma . Esophageal cancer .
Esophagogastric junction . Survival
Introduction
Esophageal cancer is the 8th most common cancer in the world, and its incidence is increasing. The two major histo-logical types of esophageal cancer include squamous cell carcinoma (SCC) and adenocarcinoma (AC). SCC of the esophagus occurs in more than 90 % of patients in Japan, China,Taiwan, and Eastern Asia; however, AC of the esophagus is more prevalent than SCC in Australia, America, and WesternEurope.13 Differences in etiology, pathogenesis, and survival also exist between AC and SCC of the esophagus, and these differences have been discussed, at length, in the literature.4,5
Adenosquamous carcinoma (ASC) is a rare malignancy which, histologically, contains elements of both...