ArticleSurgery today2026
Outcomes and prognostic factors for patients with Siewert type I/II esophagogastric junction adenocarcinoma following neoadjuvant chemotherapy and surgery: a Japanese cohort study.
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Abstract
purposeEvidence of the efficacy of neoadjuvant chemotherapy (NAC) for adenocarcinoma of the esophagogastric junction (AEG) in Japanese patients remains limited. This study evaluated the outcomes and prognostic factors for patients with locally advanced Siewert type I/II tumors treated with NAC followed by surgery.
methodsThe subjects of this retrospective analysis were 101 patients with Siewert type I/II cancer, who underwent NAC followed by surgery. The NAC regimens included S-1 plus cisplatin, S-1 plus oxaliplatin, and fluorouracil, leucovorin, oxaliplatin, and docetaxel. Progression-free survival and prognostic factors were assessed using Kaplan-Meier and Cox regression analyses.
resultsR0 resection was achieved in 93.1% of the patients, with a Grade ≥ 2 pathological response observed in 31.7%. Significant pathological downstaging was observed in both tumor and nodal stage. The 3-year progression-free survival rate was 59.5%. Multivariable analysis identified Siewert type I tumors (HR: 2.04, 95% CI: 1.10-3.79), pathological T3-4 tumors (HR: 2.93, 95% CI: 1.03-8.39), and incomplete resection (HR: 3.31, 95% CI: 1.35-8.08) as independently associated with poorer prognosis.
conclusionNAC followed by surgery was effective for locally advanced AEG in Japanese patients, yielding high R0 resection rates and favorable survival outcomes. However, Siewert type I tumors, residual pathological T3-4 disease, and incomplete resection remained adverse prognostic factors.
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