Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity

Background: Adenocarcinomas of the distal third of the oesophagus and the g astric cardia have similar characteristics but different staging criteria a re being used. In the present study the question is addressed whether these tumours should be regarded and staged as one clinical entity, Methods: From January 1987 to January 1997, 252 patients with an adenocarci noma of the oesophagus (n = 111) or gastric cardia (n = 141) underwent tran shiatal resection. Pathology, pathological tumour node metastasis (pTNM) st age and survival were analysed retrospectively, and a comparison was made b etween tumours of the oesophagus and gastric cardia. Results: Barrett's epithelium was diagnosed in 54 per cent of oesophageal a denocarcinomas compared with 13 per cent of adenocarcinomas of the gastric cardia (P < 0.001), Oesophageal carcinomas had a more favourable pT stage, fewer positive locoregional lymph nodes (pN(1-2) 56 versus. 62 per cent; P = 0.3), but more distant metastases accounted for by positive lymph nodes a round the coeliac axis (pM(1) 19 versus 4 per cent; P < 0.001). Five-year o verall survival (26 versus 27 per cent; P = 0.9) and survival according to tumour stage were no different between the groups. Multivariate analysis sh owed that the location of the primary tumour was not an independent prognos tic factor. Conclusion: Adenocarcinomas of the distal oesophagus and gastric cardia sho uld be regarded as one clinical entity, Uniform staging criteria for both m alignancies are recommended.