Siewert classification of gastroesophageal junction adenocarcinoma

vigente

Classifies adenocarcinoma by location relative to the gastroesophageal junction.

Índice de referência, não é suporte à decisão clínica. O RadCommons apresenta conteúdo de referência reescrito a partir de critérios publicados e com link para a fonte primária. Confira sempre a publicação primária vigente. Não é um dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Escala de categorias

I II III

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Procedência e vigência

Órgão emissor: Surgical consensus
Versão: 1998
Ano: 1998
Família: léxico
Tipo de lógica: flat
Modalidade: CT, MRI
Fonte primária: Classification of adenocarcinoma of the oesophagogastric junction (Siewert) · doi:10.1046/j.1365-2168.1998.00940.x
Última verificação: 2026-06-26
Última checagem: 2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "I",
    "II",
    "III"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
I	Type I Adenocarcinoma of the distal esophagus whose center (epicenter) lies 1 to 5 cm above the anatomical gastroesophageal junction (GEJ); tumor burden is essentially esophageal.	Treated as an esophageal carcinoma: the standard surgical treatment is subtotal esophagectomy with proximal gastrectomy (endoscopic treatment only at very early stage).	Highest distant-metastasis rate of the three types in the cited series (~31.5% vs ~15% for II and ~4.6% for III); overall survival did not differ significantly by Siewert type (median OS ~26.6 months overall), with stage, grade and recurrence the independent OS predictors.	okfonte Criteria & figures: PMC5448566 (Cao et al.), Introduction (type I = 1-5 cm above GEJ) and Results/Discussion (metastasis ~31.5%; OS not different by type, median ~26.6 mo; stage/grade/recurrence independent OS factors). Surgery: same source ('subtotal esophagectomy and proximal gastrectomy').
II	Type II True junctional (cardia) adenocarcinoma whose center lies within the zone from 1 cm above to 2 cm below the anatomical gastroesophageal junction (GEJ); the most controversial category as it straddles the true junction.	Distal esophagectomy with total gastrectomy is preferred for type II tumors (the source does not specify a lymphadenectomy level for type II).	Intermediate distant-metastasis rate (~15%) and intermediate disease-free survival (~14 months) in the cited series; overall survival did not differ significantly between Siewert types.	okfonte Criteria: PMC5448566 (Cao et al.), Introduction (type II = 1 cm above to 2 cm below GEJ). Management & figures: same source ('Distal esophagectomy and total gastrectomy are preferred in type II tumors'; metastasis ~15%; DFS ~14 mo; OS not different by type).
III	Type III Subcardial gastric adenocarcinoma that infiltrates the GEJ/distal esophagus from below, with its center located 2 to 5 cm below the anatomical gastroesophageal junction (GEJ); tumor burden is essentially gastric.	Treated as a gastric carcinoma: total gastrectomy with D1 (gastric-cancer-protocol) lymph node dissection.	Lowest distant-metastasis rate (~4.6%) and the longest disease-free survival (~20.8 months) of the three types in the cited series, though overall survival did not differ significantly by Siewert type (p=0.5).	okfonte Criteria: PMC5448566 (Cao et al.), Introduction (type III = 2-5 cm below GEJ). Management & figures: same source ('total gastrectomy and D1 lymph node dissection' for type III; metastasis ~4.6%; DFS ~20.8 mo; OS not different by type).

Histórico de versões

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