Prognostic Impact of Lymph Node Ratio in Adenocarcinoma of the Esophagogastric Junction: A Retrospective Analysis with Nodal Distribution Patterns

Thammawat Parakonthun; Seen Piriyanontana; Chawisa Nampoolsuksan; Tharathorn Suwatthanarak; Jirawat Swangsri; Asada Methasate

doi:10.33192/smj.v78i11.283704

Authors

Thammawat Parakonthun, M.D. Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Siriraj Upper Gastrointestinal Cancer Center, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Seen Piriyanontana, M.D. Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chawisa Nampoolsuksan, M.D. Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Siriraj Upper Gastrointestinal Cancer Center, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Tharathorn Suwatthanarak, M.D., Ph.D. Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Jirawat Swangsri, M.D., Ph.D. Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Siriraj Upper Gastrointestinal Cancer Center, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Asada Methasate, M.D., Ph.D. Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Siriraj Upper Gastrointestinal Cancer Center, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v78i11.283704

Keywords:

Adenocarcinoma, esophagogastric junction, lymph node ratio, lymph node mapping

Abstract

Objective: To evaluate the prognostic impact of the lymph node ratio (LNR) on survival in patients with adenocarcinoma of the esophagogastric junction (AEG) undergoing curative-intent surgery and to characterize patterns of lymph node distribution according to nodal station and Siewert classification.

Materials and Methods: This retrospective cohort study included patients with AEG who underwent curativeintent esophagogastrectomy at a university hospital between January 2005 and June 2022. Clinicopathological data and survival outcomes were reviewed. LNR was categorized into three groups: LNR=0, 0<LNR<0.2, and LNR≥0.2. Overall survival was analyzed using the Kaplan–Meier and Cox proportional hazards regression analyses. The distribution of nodal metastasis was evaluated using station-based lymph node mapping.

Results: Sixty-seven patients were included in the final analysis. Most patients presented with advanced-stage disease, and pathological stage III was the most common stage (41.8%). The median number of harvested lymph nodes was 34 (21, 43) nodes. Patients with LNR≥0.2 had the poorest survival outcomes, with a median overall survival of 11 months compared with 36 months for patients with 0<LNR<0.2 and 155 months for those with LNR=0 (p<0.001). On multivariate analysis, LNR≥0.2 (adjusted HR 5.90, 95%CI 2.14–16.25, p=0.001) and R1 resection (adjusted HR 2.78, 95%CI 1.16-6.93, p=0.028) remained independent predictors of poor survival. Lymph node metastases were predominantly distributed within the perigastric and celiac-axis stations.

Conclusion: Higher LNR was associated with poorer overall survival after curative-intent surgery for AEG. Given the single-center cohort and data-derived cut-off, future validation should be conducted.

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