Survival of patients with distal esophageal and gastric cardia tumors: A population-based analysis of gastroesophageal junction carcinomas

Objective: Distal esophageal tumors and gastric cardia tumors, although only physically separated by centimeters, have different staging systems and are usually treated differently. We hypothesized that gastroesophageal junction adenocarcinomas (eg, gastric cardia and distal esophageal tumors) were not distinct entities and had similar survival. Methods: Using the Surveillance, Epidemiology, and End Results database (1988-2005), we identified patients with adenocarcinomas of the distal esophagus (n = 1474) and gastric cardia (n = 192). We performed an unadjusted survival analysis using the Kaplan-Meier method, and we used a Cox proportional hazards regression model to adjust for potential confounding covariates. A 2-sided significance level was used for all statistical testing. Results: Even after adjusting for potential confounding covariates (location, stage, race, cancer-directed surgery, and radiation therapy), we found no significant difference between distal esophageal and gastric cardia tumors with regard to overall (hazard ratio, 1.18; 95% confidence interval, 0.99-1.41) and cancer-specific (hazard ratio, 1.09; 95% confidence interval, 0.90-1.31) survival. Both cancer-directed surgery (hazard ratio, 0.45; 95% confidence interval, 0.37-0.54) and radiation therapy (hazard ratio, 0.63; 95% confidence interval, 0.55-0.71) had a beneficial influence on survival. Conclusion: Through a large, population-based analysis of gastric cardia and distal esophageal adenocarcinomas, we found that patients with gastroesophageal junction adenocarcinomas have similar survival rates. Cancer-directed surgery was beneficial. Adenocarcinomas of the gastroesophageal junction are not distinct entities delineated by anatomic boundaries and as such should be managed by one skilled in both esophageal and gastric resections.