Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma

Noriya Uedo, Toshiyuki Yoshio, Shigetaka Yoshinaga, Manabu Takeuchi, Waku Hatta, Tomonori Yano, Tokuma Tanuma, Osamu Goto, Akiko Takahashi, Daniel Tong, Yeong Yeh Lee, Yoshiko Nakayama, Shin Ichihara, Takuji Gotoda

Research output: Contribution to journalArticle

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Abstract

Background and Aim: Western studies have suggested two distinct etiologies of esophagogastric junction (EGJ) cancer: Helicobacter pylori-associated atrophic gastritis and non-atrophic gastric mucosa resembling esophageal adenocarcinoma. The present study investigated whether endoscopic gastric mucosal atrophy can distinguish between these two types of EGJ adenocarcinoma. Methods: Data were collected from patients with Siewert type II, T1 EGJ adenocarcinoma who underwent endoscopic or surgical resection at eight Japanese institutions in 2010–2015. Clinicopathological characteristics of EGJ cancers with and without endoscopic gastric mucosal atrophy were compared. EGJ was defined as the lower end of the palisade vein and/or the top of the gastric folds. Results: Of the 229 patients identified, 161 had endoscopic gastric mucosal atrophy and 68 did not. The latter group was younger (64 vs 70 years, P = 0.000); had a higher proportion of patients negative for H. pylori (90% vs 47%, P < 0.0001); and had higher rates of gastroesophageal reflux disease symptoms (43% vs 12%, P = 0.017), mucosal breaks (25% vs 15%, P = 0.009), Barrett's esophagus (BE, 78% vs 42%, P < 0.0001), and tumors above the EGJ (81% vs 19%, P < 0.0001) and on the upper-right side (74% vs 38%, P < 0.0001) than the former group. Multivariate analysis showed that H. pylori positivity (odds ratio [OR] = 13.0, P < 0.001), long-segment BE (OR = 0.025, P = 0.033), and longitudinal (OR = 8.6, P = 0.001) and circumferential (OR = 4.7, P = 0.006) tumor locations were independently associated with gastric mucosal atrophy. Conclusion: Two distinct types of EGJ cancer were identified, with and without endoscopic gastric mucosal atrophy. These types were associated with different tumor locations.

Original languageEnglish
Pages (from-to)26-36
Number of pages11
JournalDigestive Endoscopy
Volume29
DOIs
Publication statusPublished - 2017 Apr 1

Fingerprint

Esophagogastric Junction
Atrophy
Stomach
Adenocarcinoma
Odds Ratio
Neoplasms
Pylorus
Atrophic Gastritis
Barrett Esophagus
Gastroesophageal Reflux
Gastric Mucosa
Helicobacter pylori
Veins
Multivariate Analysis

Keywords

  • atrophic gastritis
  • esophageal neoplasm
  • esophagogastric junction
  • Helicobacter pylori
  • stomach neoplasm

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma. / Uedo, Noriya; Yoshio, Toshiyuki; Yoshinaga, Shigetaka; Takeuchi, Manabu; Hatta, Waku; Yano, Tomonori; Tanuma, Tokuma; Goto, Osamu; Takahashi, Akiko; Tong, Daniel; Lee, Yeong Yeh; Nakayama, Yoshiko; Ichihara, Shin; Gotoda, Takuji.

In: Digestive Endoscopy, Vol. 29, 01.04.2017, p. 26-36.

Research output: Contribution to journalArticle

Uedo, N, Yoshio, T, Yoshinaga, S, Takeuchi, M, Hatta, W, Yano, T, Tanuma, T, Goto, O, Takahashi, A, Tong, D, Lee, YY, Nakayama, Y, Ichihara, S & Gotoda, T 2017, 'Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma', Digestive Endoscopy, vol. 29, pp. 26-36. https://doi.org/10.1111/den.12849
Uedo, Noriya ; Yoshio, Toshiyuki ; Yoshinaga, Shigetaka ; Takeuchi, Manabu ; Hatta, Waku ; Yano, Tomonori ; Tanuma, Tokuma ; Goto, Osamu ; Takahashi, Akiko ; Tong, Daniel ; Lee, Yeong Yeh ; Nakayama, Yoshiko ; Ichihara, Shin ; Gotoda, Takuji. / Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma. In: Digestive Endoscopy. 2017 ; Vol. 29. pp. 26-36.
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abstract = "Background and Aim: Western studies have suggested two distinct etiologies of esophagogastric junction (EGJ) cancer: Helicobacter pylori-associated atrophic gastritis and non-atrophic gastric mucosa resembling esophageal adenocarcinoma. The present study investigated whether endoscopic gastric mucosal atrophy can distinguish between these two types of EGJ adenocarcinoma. Methods: Data were collected from patients with Siewert type II, T1 EGJ adenocarcinoma who underwent endoscopic or surgical resection at eight Japanese institutions in 2010–2015. Clinicopathological characteristics of EGJ cancers with and without endoscopic gastric mucosal atrophy were compared. EGJ was defined as the lower end of the palisade vein and/or the top of the gastric folds. Results: Of the 229 patients identified, 161 had endoscopic gastric mucosal atrophy and 68 did not. The latter group was younger (64 vs 70 years, P = 0.000); had a higher proportion of patients negative for H. pylori (90{\%} vs 47{\%}, P < 0.0001); and had higher rates of gastroesophageal reflux disease symptoms (43{\%} vs 12{\%}, P = 0.017), mucosal breaks (25{\%} vs 15{\%}, P = 0.009), Barrett's esophagus (BE, 78{\%} vs 42{\%}, P < 0.0001), and tumors above the EGJ (81{\%} vs 19{\%}, P < 0.0001) and on the upper-right side (74{\%} vs 38{\%}, P < 0.0001) than the former group. Multivariate analysis showed that H. pylori positivity (odds ratio [OR] = 13.0, P < 0.001), long-segment BE (OR = 0.025, P = 0.033), and longitudinal (OR = 8.6, P = 0.001) and circumferential (OR = 4.7, P = 0.006) tumor locations were independently associated with gastric mucosal atrophy. Conclusion: Two distinct types of EGJ cancer were identified, with and without endoscopic gastric mucosal atrophy. These types were associated with different tumor locations.",
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author = "Noriya Uedo and Toshiyuki Yoshio and Shigetaka Yoshinaga and Manabu Takeuchi and Waku Hatta and Tomonori Yano and Tokuma Tanuma and Osamu Goto and Akiko Takahashi and Daniel Tong and Lee, {Yeong Yeh} and Yoshiko Nakayama and Shin Ichihara and Takuji Gotoda",
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T1 - Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma

AU - Uedo, Noriya

AU - Yoshio, Toshiyuki

AU - Yoshinaga, Shigetaka

AU - Takeuchi, Manabu

AU - Hatta, Waku

AU - Yano, Tomonori

AU - Tanuma, Tokuma

AU - Goto, Osamu

AU - Takahashi, Akiko

AU - Tong, Daniel

AU - Lee, Yeong Yeh

AU - Nakayama, Yoshiko

AU - Ichihara, Shin

AU - Gotoda, Takuji

PY - 2017/4/1

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N2 - Background and Aim: Western studies have suggested two distinct etiologies of esophagogastric junction (EGJ) cancer: Helicobacter pylori-associated atrophic gastritis and non-atrophic gastric mucosa resembling esophageal adenocarcinoma. The present study investigated whether endoscopic gastric mucosal atrophy can distinguish between these two types of EGJ adenocarcinoma. Methods: Data were collected from patients with Siewert type II, T1 EGJ adenocarcinoma who underwent endoscopic or surgical resection at eight Japanese institutions in 2010–2015. Clinicopathological characteristics of EGJ cancers with and without endoscopic gastric mucosal atrophy were compared. EGJ was defined as the lower end of the palisade vein and/or the top of the gastric folds. Results: Of the 229 patients identified, 161 had endoscopic gastric mucosal atrophy and 68 did not. The latter group was younger (64 vs 70 years, P = 0.000); had a higher proportion of patients negative for H. pylori (90% vs 47%, P < 0.0001); and had higher rates of gastroesophageal reflux disease symptoms (43% vs 12%, P = 0.017), mucosal breaks (25% vs 15%, P = 0.009), Barrett's esophagus (BE, 78% vs 42%, P < 0.0001), and tumors above the EGJ (81% vs 19%, P < 0.0001) and on the upper-right side (74% vs 38%, P < 0.0001) than the former group. Multivariate analysis showed that H. pylori positivity (odds ratio [OR] = 13.0, P < 0.001), long-segment BE (OR = 0.025, P = 0.033), and longitudinal (OR = 8.6, P = 0.001) and circumferential (OR = 4.7, P = 0.006) tumor locations were independently associated with gastric mucosal atrophy. Conclusion: Two distinct types of EGJ cancer were identified, with and without endoscopic gastric mucosal atrophy. These types were associated with different tumor locations.

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