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Background <p>Conventional classifications of T1 adenocarcinoma at the esophagogastric junction (T1-AEGJ) rely on lymph node metastasis patterns and define AEGJ according to the distance between the tumor epicenter and esophagogastric junction (EGJ). However, their significance in T1-AEGJs remains unclear due to the low frequency of lymph node metastasis. Thus, classifications based solely on tumor epicenter may encompass tumors with distinct biological behaviors, particularly those in the stomach. Therefore, we aimed to elucidate the characteristics of T1-AEGJs localized in the stomach.</p> Methods <p>We retrospectively analyzed 266 patients with pT1-AEGJs who underwent endoscopic or surgical resection between 2010 and 2023. Tumors were classified into Groups E (confined to the esophagus or crossing the EGJ) and G (localized in the stomach). Clinicopathological features were compared between the groups, and risk factors for deep submucosal invasion (SM &gt; 500&#xa0;μm) were evaluated using multivariate analysis.</p> Results <p>Patients in Group G were older and had a higher prevalence of <i>Helicobacter pylori</i> infection (64.9% vs. 30.8%) and intestinal metaplasia (71.6% vs. 43.1%). Conversely, patients in Group E had more incidences of hiatal hernia (42.5% vs. 20.3%), gastroesophageal reflux disease (43.4% vs. 22.4%), Barrett’s esophagus (47.6% vs. 9.0%), and deep submucosal invasion (45.4% vs. 27.8%). Tumor size ≥ 20&#xa0;mm, EGJ extension, depressed or protruded morphology, and undifferentiated biopsy histology were identified as independent risk factors for deep invasion.</p> Conclusions <p>T1-AEGJ tumors in the stomach demonstrate distinct clinicopathological features. Therefore, a classification based on EGJ extension, and not just epicenter, may improve their risk assessment and treatment decisions.</p>

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Clinicopathological features in T1 adenocarcinoma of the esophagogastric junction: a new perspective on tumor localization

  • 期刊论文

  • 发表日期：

    2026年4月6日

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  • Shunsuke Ueda,
  • Masao Yoshida,
  • Tadakazu Shimoda,
  • Yoichi Yamamoto,
  • Noboru Kawata,
  • Kazunori Takada,
  • Kenichiro Imai,
  • Kinichi Hotta,
  • Hiroyuki Matsubayashi,
  • Hiroyuki Ono

摘要

Background

Conventional classifications of T1 adenocarcinoma at the esophagogastric junction (T1-AEGJ) rely on lymph node metastasis patterns and define AEGJ according to the distance between the tumor epicenter and esophagogastric junction (EGJ). However, their significance in T1-AEGJs remains unclear due to the low frequency of lymph node metastasis. Thus, classifications based solely on tumor epicenter may encompass tumors with distinct biological behaviors, particularly those in the stomach. Therefore, we aimed to elucidate the characteristics of T1-AEGJs localized in the stomach.

Methods

We retrospectively analyzed 266 patients with pT1-AEGJs who underwent endoscopic or surgical resection between 2010 and 2023. Tumors were classified into Groups E (confined to the esophagus or crossing the EGJ) and G (localized in the stomach). Clinicopathological features were compared between the groups, and risk factors for deep submucosal invasion (SM > 500 μm) were evaluated using multivariate analysis.

Results

Patients in Group G were older and had a higher prevalence of Helicobacter pylori infection (64.9% vs. 30.8%) and intestinal metaplasia (71.6% vs. 43.1%). Conversely, patients in Group E had more incidences of hiatal hernia (42.5% vs. 20.3%), gastroesophageal reflux disease (43.4% vs. 22.4%), Barrett’s esophagus (47.6% vs. 9.0%), and deep submucosal invasion (45.4% vs. 27.8%). Tumor size ≥ 20 mm, EGJ extension, depressed or protruded morphology, and undifferentiated biopsy histology were identified as independent risk factors for deep invasion.

Conclusions

T1-AEGJ tumors in the stomach demonstrate distinct clinicopathological features. Therefore, a classification based on EGJ extension, and not just epicenter, may improve their risk assessment and treatment decisions.