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Background To evaluate the prognostic impact of the advanced lung cancer index (ALI) in patients with the adenocarcinoma of esophagogastric junction (AEG) after radical resection. Methods The data of patients with AEG after radical resection at Guangdong Provincial People’s Hospital from January 2008 to December 2018 were retrieved. The cutoff value of ALI was determined and the prognostic impact of clinicopathological factors and ALI were analyzed. A nomogram based on the independent prognostic factors for overall survival was then built. Results A total of 147 patients were eligible and based on a cutoff of ALI 43.1, 90 (61.2%) and 57 (38.8%) patients were classified in a low- (ALI༜43.1) and high-ALI (ALI༞43.1) group. Multivariate Cox proportional hazard analysis showed that low-ALI was associated with poor overall survival (OS) (p༜0.001, HR 2.541, 95%CI 1.408-4.410) and disease-free survival (DFS) (p=0.021, HR 1.789, 95%CI 1.020-2.674). In subgroup analysis, low-ALI was independent predictor for OS (p=0.001, HR 2.628, 95%CI 1.467-4.707) in stage III/IVA AEG patients. A nomogram for OS estimation was constructed and the C-index was 0.699 (95%CI 0.636-0.762) and the calibration plots showed satisfactory consistency between actual observation and nomogram-predicted OS probabilities. Further, satisfactory predictive accuracy for 1-, 2-, and 3-year OS rates with an area under the curve of 0.736, 0.712 and 0.697, respectively, was observed. Conclusions ALI was an independent prognostic factor for AEG patients after radical resection, and demonstrated promising ability for risk stratification of AEG, especially in advanced-stage disease.

BackgroundThe incidence of esophagogastric junction adenocarcinoma (EJA) has increased in recent years, with surgical resection the main choice of treatment. The optimal length of the proximal margin for EJA is still under debate, and the impact of EJA survival and recurrence remains unclear. The aim of the present study was to investigate the influence of the optimal length of the proximal margin on EJA.MethodsFrom January 2011 to December 2015, 131 patients who had EJA with type II tumors were included and retrospectively analyzed. All patients underwent radical R0 resection. The proximal margin was measured promptly after resection, and the frozen-section pathological examination was negative for the margin.ResultsThere were 3 cases of Siewert type I EJA (2.9 %), 75 cases of Siewert type II EJA (57.9 %), and 53 cases (40.1%) of Siewert type III EJA. The median number of lymph nodes examined was 19 (range: 1–41), and the median number of positive lymph nodes was 2 (range: 0–18). Sixty-three patients underwent total gastrectomy (48.1%), and 68 underwent proximal gastrectomy (51.9%). The median follow-up time was 57.3 months: (range 1.9–174.1); 34 patients (26%) relapsed and 74 (56.5%) died. The 5-year overall survival rate of type II tumor patients was 68.2%, and that of type III tumor patients was 38.5% (P = 0.02). For patients with a proximal margin 2 cm (log–rank: 0.496). Our data analysis found that a proximal margin length of 2 cm was a prognostic variable for type II and type III tumors.ConclusionsThere are a number of factors associated with recurrence and overall survival at 5 years for patients who have EJA with type II and type III tumors, and a proximal margin >2 cm may indicate better prognosis.

Background: Postoperative complications (PCs) after laparoscopic gastrectomy with mediastinal lymph nodes resection for adenocarcinoma of esophagogastric junction (AEG) prolonged the time of hospitalization and increased mortality rate. Early diagnosis of PCs was of great importance. This retrospective study aimed to investigate whether the variation tendency of serum C-reactive protein can be used as an early marker to predict major postoperative complications after laparoscopic gastrectomy for AEG.Methods: Data for patients underwent laparoscopic gastrectomy for AEG, from January 2015 to March 2020, were retrospectively analyzed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to determine diagnostic accuracy of inflammatory markers. The optimal cutoff values were calculated by maximizing Youden’s index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PCs of grade III or more，according to the Clavien-Dindo classification. Results: A total of 114 patients were analyzed, of whom 21 (18.4%, 95% CI 11.4-25.4 %) developed major PCs, including anastomotic leakage in 13. The ratio of CRP level on postoperative day 3 to day 2 (POD3/2 CRP) provided the best diagnostic accuracy (AUC 0.903, 95% CI 0.814-0.993, p＜0.001). Proximal gastrectomy (OR 8.224, 95% CI 1.976-34.234, p=0.004) and operation time ≥360 minutes (OR 6.753, 95% CI 2.037-22.395, p=0.002) were identified as significant independent risk factors for major PCs.Conclusions: The POD3/2 CRP was the best marker to predict PCs after laparoscopic gastrectomy for AEG.

Backgroud:Esophagojejunal anastomotic leakage (EJAL) after laparoscopic gastrectomy with mediastinal lymph nodes resection for adenocarcinoma of esophagogastric junction (AEG) constituted the most common and serious postoperative complications (PCs). Early diagnosis of EJAL was of great importance. This retrospective study aimed to investigate whether the variation tendency of serum C-reactive protein can be used as an early marker to exclude EJAL after laparoscopic gastrectomy for AEG.Methods:Data for patients underwent laparoscopic gastrectomy for AEG, from January 2015 to March 2020, were retrospectively analyzed. Diagnostic accuracy was determined by the area under the receiver operating characteristic curve. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PCs of grade II or more，according to the Clavien-Dindo classification. Results:A total of 114 patients were analyzed, of whom 21 (18.4%, 95% CI 11.4-25.4 %) developed major PCs, including anastomotic leakage in 13. The ratio of CRP level on postoperative day 3 to day 2 (POD3/2 CRP) provided the best diagnostic accuracy (AUC 0.903, 95% CI 0.814-0.993, p＜0.001). Proximal gastrectomy (OR 8.224, 95% CI 1.976-34.234, p=0.004) and operation time ≥360 minutes (OR 6.753, 95% CI 2.037-22.395, p=0.002) were identified as significant independent risk factors for major postoperative complications.Conclusions:The POD3/2 CRP was the best marker to exclude anastomotic leakage after laparoscopic gastrectomy for AEG.