TUMORS OF THE ESOPHAGOGASTRIC JUNCTION - LONG-TERM SURVIVAL IN RELATION TO THE PATTERN OF LYMPH-NODE METASTASIS AND CRITICAL ANALYSIS OF THE ACCURACY OR INACCURACY OF PTNM CLASSIFICATION

From 1983 to 1989, 95 patients with carcinoma of the esophagogastric j unction underwent resection. Overall hospital mortality rate was 6.2% (6/95). Actuarial survival analysis showed 5- and 10-year survivals of 33% and 31%, respectively. Five- and 10-year survivals of patients ac cording to TNM stages were as follows: stage I (n = 13), 90% at both 5 and 10 years; stage II (n = 13), 70% at both intervals; stage III (n = 28), 28% at both intervals; and stage IV (n = 40), 11% and 8%, respe ctively. For patients with undiseased nodes (n = 26), 5- and 10-year s urvivals were 72% and 72%, compared with 18% and 16% for patients with diseased nodes (n = 68; p < 0.005). In patients who had involvement o f both the abdominal and thoracic lymph nodes (n = 28), 5- and 10-year survivals were 13% and 13%, compared with 26% and 26% if metastases w ere confined to the abdomen (n = 37; p > 0.05). Grouping patients with diseased intrathoracic nodes together with patients with N2 abdominal nodes showed survivals of 14% at both 5 and 10 years. When tumors wer e staged as an esophageal carcinoma, classification of individual pati ents changed, as did the 5- and 10-year survivals. Five- and 10-year s urvivals were as follows: stage I (n = 8), 100% for both 5 and 10 year s; stage II (n = 18), 68% for both 5 and 10 years; stage III (n = 27), 37% for both 5 and 10 years; and stage IV (n = 41), 10% for 5 years a nd 6% for 10 years. These data indicate that tumors of the esophagogas tric junction tend to spread to both abdominal and thoracic nodes. How ever, reasonably good 5- and 10-year survivals can be obtained even in patients with nodal metastases in both areas. We suggest that N2 labe ling be included for thoracic node metastases instead of the actual MLy label, because the N2 label better reflects the potential for curat ive surgery. Finally, staging tumors as gastric or esophageal carcinom a makes no significant difference in survival analysis, which raises t he question whether these tumors behave more like esophageal carcinoma than gastric carcinoma.