Modified classification for adenocarcinoma of the gastro-oesophageal junction

Shearer, C., Going, J., Neilson, L. and Stuart, R. (2007) Modified classification for adenocarcinoma of the gastro-oesophageal junction. ANZ Journal of Surgery, 77(7), pp. 544-549. (doi: 10.1111/j.1445-2197.2007.04147.x)

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Background: Incidence of the gastro-oesophageal junction adenocarcinoma is increasing. Siewert's classification subdivides junctional adenocarcinomas anatomically. Cytokeratin (CK) 7 and 20 immunophenotypes differentiate Barrett's intestinal metaplasia (IM) from gastric IM. Comparing CK immunostaining with Siewert's classification may establish tumour origin and influence surgical choice. Methods: In this experimental study, 57 patients with gastro-oesophageal junction adenocarcinoma were subdivided endoscopically into 15 type 1, 26 type 2 and 16 type 3 adenocarcinomas. Representative biopsies were immunostained for CK7 and CK20. Results: Intestinal metaplasia was associated with type 1 adenocarcinoma in 12 of 15 patients, 80%; with type 2 in 13 of 26 patients, 50% and type 3 in 6 of 16 patients, 37.5%. All type 1 patients showed Barrett's CK7/CK20 phenotype within IM; type 2 a mixture: 69% (n = 9) Barrett's CK7/CK20 and 31% (n = 4) gastric CK7/CK20 whereas type 3 patients had a gastric CK7/CK20 pattern in 83% (n = 5). Immunostaining within the adenocarcinoma was variable. Conclusion: Siewert's type 1 adenocarcinomas express Barrett's CK7/CK20 pattern, type 3 a gastric CK7/CK20 pattern and type 2 tumours a mixture of Barrett's and gastric CK7/CK20 patterns within associated IM. CK immunostaining may refine Siewert's classification into oesophageal type 1 or gastric type 2 adenocarcinoma with IM.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Going, Dr James
Authors: Shearer, C., Going, J., Neilson, L., and Stuart, R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:ANZ Journal of Surgery

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