The prognostic relevance of parapyloric lymph node metastasis in Siewert type II/III adenocarcinoma of the esophagogastric junction

Introduction: The purpose of this study was to evaluate the prognosis of patients with Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) with parapyloric lymph node (No. 5 and 6 lymph nodes, PLN) metastasis and to determine the need for PLN dissection for patients with type II/III AEG. Methods: A total of 1008 patients with type II/III AEG who underwent a transabdominal total gastrectomy were enrolled. The long-term surgical outcome of PLN-positive patients and the therapeutic value of PLN dissection were analyzed. Results: There was no significant difference in the incidence of PLN metastasis between type II and III cancers (5.7% vs. 8.5%, P > 0.05). PLN metastasis was a significant prognostic factor for type II/III cancers (HR 1.66; P = 0.001). Among the type II/III cancers, the 5-year survival of patients with PLN-positive cancers was much lower than that of patients with PLN-negative cancers (21.3% vs. 60.8%, P < 0.001). Even after radical resection, the 5-year survival of patients with stage I-III PLN-positive cancers was similar to that of patients with stage IV cancers without PLN metastasis (23.5% vs. 23.1%, P > 0.05). In the analysis of the therapeutic value of lymph node dissection in each station for type II (373) and III cancers (572) after radical resection, lymph nodes with the lowest therapeutic value index after No. 12a were the No. 5 and 6 lymph nodes (Type II: No. 5, 0.5; No. 6, 0.3; Type III: No. 5, 1.4; No. 6, 1.1). Conclusion: Patients with Siewert type II/III AEG with PLN metastasis have a poor prognosis, similar to patients with stage IV disease. PLN dissection offers marginal therapeutic value for patients with type II/III AEG.