Characteristics and Long-Term Outcome of Adenocarcinoma of the Esophagogastric Junction: A 23-Year Experience at a Tertiary Hospital in Thailand

Background: Adenocarcinoma of the esophagogastric junction (AEG) has risen significantly worldwide in recent decades. Eastern and western countries report differences in disease characteristics and treatment strategies. However, the Southeast Asian AEG data remains extremely limited. Objective: To demonstrate the clinicopathological characteristics and surgical treatment outcomes of AEG in Thai patients. Materials and Methods: The authors conducted retrospective review of 106 AEG patients who underwent curative resection at a university hospital in Thailand between 1998 and 2020. All patients were classified by the Siewert classification. The clinicopathological characteristics, operative outcomes, and survival outcomes were reported and compared between each subtype. The chi-square test was utilized to compare categorical variables, whereas, the one-way ANOVA test was used to analyze continuous data. Survival outcomes were calculated using the Kaplan-Meier method, and the log-rank test was employed to compare the variables that impact survival. Results: Of 106 patients, 13 patients (12.3%) were classified as Siewert type 1, 56 patients (52.8%) as Siewert type 2, and 37 patients (34.9%) as Siewert type 3 tumors. Most type 1 patients (76.9%) underwent Ivor-Lewis esophagectomy, whereas 60.7% and 81.1% of type 2 and type 3 patients, respectively, received extended gastrectomy. The overall 30-day mortality was 1.9%. The cohort revealed a 5-year survival rate of 25.4%, with a median survival of 17 months. Multivariate analysis showed that poor survival was significantly associated to age older than 65 years (HR 2.54, 95% CI 1.51 to 4.28), higher pN stage (HR 2.63, 95% CI 1.48 to 4.67), and higher histologic grade (HR 2.06, 95% CI 1.25 to 3.39). Conclusion: The present study is the first study on AEG in Thailand, showing increasing number comparable to those in Western countries. A greater proportion of AEG cases in Thailand were classified as Siewert types 2 and 3. The survival prognosis was still unfavorable and requires improvement in upcoming instances.