Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 6, December 2023, pages 307-317

Marital Status Is a Prognostic Factor for Cardiovascular Mortality but Not a Prognostic Factor for Cancer Mortality in Siewert Type II Adenocarcinoma of the Esophagogastric Junction

Figure 1. Eligibility, inclusion, and exclusion criteria of the study population. AEG: adenocarcinoma of the esophagogatric junction.

Figure 2. Kaplan-Meier survival analysis for married and unmarried Siewert type II AEG patients. Overall survival curves for the married and unmarried group before (a) and after PSM (b). Cancer-specific survival curves for the married and unmarried group before (c) and after PSM (d). Cardiovascular specific survival curves for the married and unmarried group before (e) and after PSM (f). AEG: adenocarcinoma of the esophagogatric junction; PSM: propensity score matching.

Figure 3. Cumulative incidence of cancer specific death and non-cancer specific death in married and unmarried Siewert type II AEG patients before (a) and after PSM (b). AEG: adenocarcinoma of the esophagogatric junction; PSM: propensity score matching.

Figure 4. Cumulative incidence of cardiovascular death and non-cardiovascular specific death in married and unmarried Siewert type II AEG patients before (a) and after PSM (b). AEG: adenocarcinoma of the esophagogatric junction; PSM: propensity score matching.

**Table 1.** Baseline Clinical Characteristics of Patients With Siewert Type II AEG
Variables	Before PSM, N (%)	After PSM, N (%)
AEG: adenocarcinoma of the esophagogatric junction; LNR: lymph node metastasis ratio; PSM: propensity score matching; RLN: number of removed lymph nodes.
N	1149	474		474	474
Age			0.025			0.22
≤ 56	296 (25.8%)	148 (31.2%)		135 (28.5%)	148 (31.2%)
56 - 75	725 (63.1%)	265 (55.9%)		290 (61.2%)	265 (55.9%)
> 75	128 (11.1%)	61 (12.9%)		49 (10.3%)	61 (12.9%)
Sex			< 0.001			0.04
Male	981 (85.4%)	347 (73.2%)		375 (79.1%)	347 (73.2%)
Female	168 (14.6%)	127 (26.8%)		99 (20.9%)	127 (26.8%)
Race			< 0.001			< 0.001
White	1003 (85.4%)	404 (85.2%)		404 (85.2%)	404 (85.2%)
Black	41 (3.6%)	39 (8.2%)		12 (2.5%)	39 (8.2%)
Other	105 (9.1%)	31 (6.5%)		58 (12.2%)	31 (6.5%)
Grade			0.882			0.462
G1	69 (6.0%)	33 (7.0%)		22 (4.6%)	33 (7.0%)
G2	436 (37.9%)	177 (37.3%)		178 (37.6%)	177 (37.3%)
G3	624 (54.3%)	257 (54.2%)		265 (55.9%)	257 (54.2%)
G4	20 (1.7%)	7 (1.5%)		9 (1.9%)	7 (1.5%)
Stage			0.088			0.105
I	234 (20.4%)	85 (17.9%)		93 (19.6%)	85 (17.9%)
II	285 (24.8%)	142 (30.0%)		113 (23.8%)	142 (30.0%)
III	630 (54.8%)	247 (52.1%)		268 (56.5%)	247 (52.1%)
T stage			0.232			0.228
T1	229 (19.9%)	95 (20.0%)		83 (17.5%)	95 (20.0%)
T2	179 (15.6%)	58 (12.2%)		79 (16.7%)	58 (12.2%)
T3	680 (59.2%)	288 (60.8%)		283 (59.7%)	288 (60.8%)
T4	61 (5.3%)	33 (7.0%)		29 (6.1%)	33 (7.0%)
N stage			0.077			0.076
N0	428 (37.2%)	191 (40.3%)		174 (36.7%)	191 (40.3%)
N1	399 (34.7%)	143 (30.2%)		174 (36.7%)	143 (30.2%)
N2	205 (17.8%)	76 (16.0%)		80 (16.9%)	76 (16.0%)
N3	117 (10.2%)	64 (13.5%)		46 (9.7%)	64 (13.5%)
RLN			0.911			0.799
≤ 10	294 (25.6%)	120 (25.3%)		117 (24.7%)	120 (25.3%)
10 - 16	308 (26.8%)	132 (27.8%)		125 (26.4%)	132 (27.8%)
> 16	547 (47.6%)	222 (46.8%)		232 (48.9%)	222 (46.8%)
LNR			0.118			0.177
≤ 4.2	619 (53.9%)	258 (54.4%)		264 (55.7%)	258 (54.4%)
4.2 - 16.7	245 (21.3%)	82 (17.3%)		98 (20.7%)	82 (17.3%)
> 16.7	285 (24.8%)	134 (28.3%)		112 (23.6%)	134 (28.3%)
Tumor size			0.338			0.966
≤ 19	207 (15.6%)	74 (15.6%)		73 (15.4%)	74 (15.6%)
19 - 44	522 (45.4%)	211 (44.5%)		215 (45.4%)	211 (44.5%)
> 44	420 (36.6%)	189 (39.9%)		186 (39.2%)	189 (39.9%)
Chemotherapy			0.148			0.042
Yes	840 (73.1%)	329 (69.4%)		358 (75.5%)	329 (69.4%)
No	309 (26.9%)	145 (30.6%)		116 (24.5%)	145 (30.6%)
Radiotherapy			0.325			0.064
Yes	677 (58.9%)	266 (56.1%)		295 (62.2%)	266 (56.1%)
No	472 (41.1%)	208 (43.9%)		179 (37.8%)	208 (43.9%)
Dead			< 0.001			< 0.001
Alive	516 (44.9%)	170 (35.9%)		213 (44.9%)	170 (35.9%)
AEG	547 (47.6%)	247 (52.1%)		228 (48.1%)	247 (52.1%)
Cardiovascular	33 (2.9%)	26 (5.5%)		8 (1.7%)	26 (5.5%)
Other	53 (4.6%)	31 (6.5%)		25 (5.3%)	31 (6.5%)

Table 1. Baseline Clinical Characteristics of Patients With Siewert Type II AEG

Variables

Before PSM, N (%)

After PSM, N (%)

Married

Unmarried

Married

Unmarried

AEG: adenocarcinoma of the esophagogatric junction; LNR: lymph node metastasis ratio; PSM: propensity score matching; RLN: number of removed lymph nodes.

1149

474

Age

0.025

0.22

≤ 56

296 (25.8%)

148 (31.2%)

135 (28.5%)

148 (31.2%)

56 - 75

725 (63.1%)

265 (55.9%)

290 (61.2%)

265 (55.9%)

> 75

128 (11.1%)

61 (12.9%)

49 (10.3%)

61 (12.9%)

Sex

< 0.001

0.04

Male

981 (85.4%)

347 (73.2%)

375 (79.1%)

347 (73.2%)

Female

168 (14.6%)

127 (26.8%)

99 (20.9%)

127 (26.8%)

Race

< 0.001

White

1003 (85.4%)

404 (85.2%)

Black

41 (3.6%)

39 (8.2%)

12 (2.5%)

39 (8.2%)

Other

105 (9.1%)

31 (6.5%)

58 (12.2%)

31 (6.5%)

Grade

0.882

0.462

69 (6.0%)

33 (7.0%)

22 (4.6%)

33 (7.0%)

436 (37.9%)

177 (37.3%)

178 (37.6%)

177 (37.3%)

624 (54.3%)

257 (54.2%)

265 (55.9%)

257 (54.2%)

20 (1.7%)

7 (1.5%)

9 (1.9%)

7 (1.5%)

Stage

0.088

0.105

234 (20.4%)

85 (17.9%)

93 (19.6%)

85 (17.9%)

285 (24.8%)

142 (30.0%)

113 (23.8%)

142 (30.0%)

III

630 (54.8%)

247 (52.1%)

268 (56.5%)

247 (52.1%)

T stage

0.232

0.228

229 (19.9%)

95 (20.0%)

83 (17.5%)

95 (20.0%)

179 (15.6%)

58 (12.2%)

79 (16.7%)

58 (12.2%)

680 (59.2%)

288 (60.8%)

283 (59.7%)

288 (60.8%)

61 (5.3%)

33 (7.0%)

29 (6.1%)

33 (7.0%)

N stage

0.077

0.076

428 (37.2%)

191 (40.3%)

174 (36.7%)

191 (40.3%)

399 (34.7%)

143 (30.2%)

174 (36.7%)

143 (30.2%)

205 (17.8%)

76 (16.0%)

80 (16.9%)

76 (16.0%)

117 (10.2%)

64 (13.5%)

46 (9.7%)

64 (13.5%)

RLN

0.911

0.799

≤ 10

294 (25.6%)

120 (25.3%)

117 (24.7%)

120 (25.3%)

10 - 16

308 (26.8%)

132 (27.8%)

125 (26.4%)

132 (27.8%)

> 16

547 (47.6%)

222 (46.8%)

232 (48.9%)

222 (46.8%)

LNR

0.118

0.177

≤ 4.2

619 (53.9%)

258 (54.4%)

264 (55.7%)

258 (54.4%)

4.2 - 16.7

245 (21.3%)

82 (17.3%)

98 (20.7%)

82 (17.3%)

> 16.7

285 (24.8%)

134 (28.3%)

112 (23.6%)

134 (28.3%)

Tumor size

0.338

0.966

≤ 19

207 (15.6%)

74 (15.6%)

73 (15.4%)

74 (15.6%)

19 - 44

522 (45.4%)

211 (44.5%)

215 (45.4%)

211 (44.5%)

> 44

420 (36.6%)

189 (39.9%)

186 (39.2%)

189 (39.9%)

Chemotherapy

0.148

0.042

Yes

840 (73.1%)

329 (69.4%)

358 (75.5%)

329 (69.4%)

309 (26.9%)

145 (30.6%)

116 (24.5%)

145 (30.6%)

Radiotherapy

0.325

0.064

Yes

677 (58.9%)

266 (56.1%)

295 (62.2%)

266 (56.1%)

472 (41.1%)

208 (43.9%)

179 (37.8%)

208 (43.9%)

Dead

< 0.001

Alive

516 (44.9%)

170 (35.9%)

213 (44.9%)

170 (35.9%)

AEG

547 (47.6%)

247 (52.1%)

228 (48.1%)

247 (52.1%)

Cardiovascular

33 (2.9%)

26 (5.5%)

8 (1.7%)

26 (5.5%)

Other

53 (4.6%)

31 (6.5%)

25 (5.3%)

31 (6.5%)

**Table 2.** Multivariable Competing Risk Analysis for Cancer-Specific Death in Patients With Siewert Type II AEG
Variables	Before PSM, N (%)	After PSM, N (%)
AEG: adenocarcinoma of the esophagogatric junction; CI: confidence interval; HR: hazard ratio; RLN: number of removed lymph nodes; PSM: propensity score matching.
Age
≤ 56	Ref		Ref
56 - 75	1.176 (1.001 - 1.380)	0.048	1.197 (0.976 - 1.469)	0.084
> 75	1.223 (0.951 - 1.572)	0.12	1.106 (0.795 - 1.539)	0.550
Sex
Male	Ref		Ref
Female	0.934 (0.773 - 1.129)	0.48	1.047 (0.839 - 1.307)	0.680
Race
White	Ref		Ref
Black	0.930 (0.682 - 1.268)	0.65	0.789 (0.521 - 1.195)	0.260
Other	0.759 (0.576 - 0.999)	0.049	0.797 (0.567 - 1.122)	0.190
Grade
G1	Ref		Ref
G2	1.232 (0.848 - 1.790)	0.27	1.588 (0.925 - 2.724)	0.093
G3	1.594 (1.103 - 2.303)	0.013	2.227 (1.311 - 3.785)	0.003
G4	1.575 (0.887 - 2.798)	0.12	1.714 (0.814 - 3.609)	0.160
T stage
T1	Ref		Ref
T2	1.745 (1.254 - 2.429)	< 0.001	1.642 (1.070 - 2.521)	0.023
T3	2.053 (1.496 - 2.819)	< 0.001	1.801 (1.199 - 2.705)	0.004
T4	2.808 (1.843 - 4.279)	< 0.001	2.276 (1.346 - 3.848)	0.002
N stage
N0	Ref		Ref
N1	1.594 (1.292 - 1.966)	< 0.001	1.500 (1.143 - 1.968)	0.004
N2	2.452 (1.948 - 3.086)	< 0.001	2.517 (1.872 - 3.386)	< 0.001
N3	3.178 (2.453 - 4.117)	< 0.001	2.790 (2.014 - 3.864)	< 0.001
RLN
≤ 10	Ref		Ref
10 - 16	0.774 (0.640 - 0.937)	0.008	0.844 (0.659 - 1.080)	0.180
> 16	0.618 (0.519 - 0.735)	< 0.001	0.634 (0.505 - 0.797)	< 0.001
Tumor size
≤ 19	Ref		Ref
19 - 44	1.159 (0.880 - 1.526)	0.30	1.223 (0.844 - 1.770)	0.290
> 44	1.313 (0.983 - 1.752)	0.065	1.700 (1.155 - 2.503)	0.007
Chemotherapy
Yes	Ref		Ref
No	1.143 (0.896 - 1.457)	0.28	1.120 (0.826 - 1.518)	0.470
Radiotherapy
Yes	Ref		Ref
No	1.046 (0.875 - 1.251)	0.62	1.198 (0.948 - 1.514)	0.130
Marital status
Married	Ref		Ref
Unmarried	1.160 (0.994 - 1.354)	0.060	1.179 (0.975 - 1.426)	0.089

Table 2. Multivariable Competing Risk Analysis for Cancer-Specific Death in Patients With Siewert Type II AEG

Variables

Before PSM, N (%)

After PSM, N (%)

HR (95% CI)

AEG: adenocarcinoma of the esophagogatric junction; CI: confidence interval; HR: hazard ratio; RLN: number of removed lymph nodes; PSM: propensity score matching.

Age

≤ 56

Ref

56 - 75

1.176 (1.001 - 1.380)

0.048

1.197 (0.976 - 1.469)

0.084

> 75

1.223 (0.951 - 1.572)

0.12

1.106 (0.795 - 1.539)

0.550

Sex

Male

Ref

Female

0.934 (0.773 - 1.129)

0.48

1.047 (0.839 - 1.307)

0.680

Race

White

Ref

Black

0.930 (0.682 - 1.268)

0.65

0.789 (0.521 - 1.195)

0.260

Other

0.759 (0.576 - 0.999)

0.049

0.797 (0.567 - 1.122)

0.190

Grade

Ref

1.232 (0.848 - 1.790)

0.27

1.588 (0.925 - 2.724)

0.093

1.594 (1.103 - 2.303)

0.013

2.227 (1.311 - 3.785)

0.003

1.575 (0.887 - 2.798)

0.12

1.714 (0.814 - 3.609)

0.160

T stage

Ref

1.745 (1.254 - 2.429)

< 0.001

1.642 (1.070 - 2.521)

0.023

2.053 (1.496 - 2.819)

< 0.001

1.801 (1.199 - 2.705)

0.004

2.808 (1.843 - 4.279)

< 0.001

2.276 (1.346 - 3.848)

0.002

N stage

Ref

1.594 (1.292 - 1.966)

< 0.001

1.500 (1.143 - 1.968)

0.004

2.452 (1.948 - 3.086)

< 0.001

2.517 (1.872 - 3.386)

< 0.001

3.178 (2.453 - 4.117)

< 0.001

2.790 (2.014 - 3.864)

< 0.001

RLN

≤ 10

Ref

10 - 16

0.774 (0.640 - 0.937)

0.008

0.844 (0.659 - 1.080)

0.180

> 16

0.618 (0.519 - 0.735)

< 0.001

0.634 (0.505 - 0.797)

< 0.001

Tumor size

≤ 19

Ref

19 - 44

1.159 (0.880 - 1.526)

0.30

1.223 (0.844 - 1.770)

0.290

> 44

1.313 (0.983 - 1.752)

0.065

1.700 (1.155 - 2.503)

0.007

Chemotherapy

Yes

Ref

1.143 (0.896 - 1.457)

0.28

1.120 (0.826 - 1.518)

0.470

Radiotherapy

Yes

Ref

1.046 (0.875 - 1.251)

0.62

1.198 (0.948 - 1.514)

0.130

Marital status

Married

Ref

Unmarried

1.160 (0.994 - 1.354)

0.060

1.179 (0.975 - 1.426)

0.089

**Table 3.** Multivariable Competing Risk Analysis for Cardiovascular Death in Patients With Siewert Type II AEG
Variables	Before PSM, N (%)	After PSM, N (%)
AEG: adenocarcinoma of the esophagogatric junction; CI: confidence interval; HR: hazard ratio; PSM: propensity score matching; RLN: number of removed lymph nodes.
Age
≤ 56	Ref		Ref
56 - 75	2.149 (0.986 - 4.680)	0.054	1.477 (0.594 - 3.670)	0.400
> 75	3.298 (1.294 - 8.410)	0.012	3.389 (1.124 - 10.220)	0.030
Sex
Male	Ref		Ref
Female	0.884 (0.452 - 1.730)	0.720	0.915 (0.408 - 2.050)	0.830
Race
White	Ref		Ref
Black	1.983 (0.899 - 4.370)	0.090	3.274 (1.398 - 7.670)	0.006
Other	1.430 (0.616 - 3.320)	0.410	1.412 (0.428 - 4.660)	0.570
Grade
G1	Ref		Ref
G2	0.394 (0.139 - 1.110)	0.079	0.702 (0.140 - 3.520)	0.670
G3	0.667 (0.244 - 1.820)	0.430	0.764 (0.153 - 3.820)	0.740
G4	0.645 (0.072 - 5.760)	0.700	1.652 (0.132 - 20.700)	0.700
T stage
T1	Ref		Ref
T2	0.817 (0.308 - 2.170)	0.690	0.987 (0.246 - 3.960)	0.990
T3	0.772 (0.338 - 1.770)	0.540	0.927 (0.286 - 3.000)	0.900
T4	0.628 (0.165 - 2.390)	0.490	0.796 (0.151 - 4.200)	0.790
N stage
N0	Ref		Ref
N1	1.520 (0.684 - 3.380)	0.300	1.288 (0.448 - 3.700)	0.640
N2	1.209 (0.461 - 3.170)	0.700	2.095 (0.685 - 6.410)	0.190
N3	1.870 (0.773 - 4.530)	0.170	2.310 (0.847 - 6.300)	0.100
RLN
≤ 10	Ref		Ref
10 - 16	0.751 (0.370 - 1.530)	0.430	0.628 (0.245 - 1.610)	0.330
> 16	0.850 (0.446 - 1.620)	0.620	0.705 (0.316 - 1.570)	0.390
Tumor size
≤ 19	Ref		Ref
19 - 44	2.227 (0.914 - 5.430)	0.078	1.925 (0.556 - 6.670)	0.300
> 44	1.755 (0.677 - 4.550)	0.250	1.207 (0.319 - 4.560)	0.780
Chemotherapy
Yes	Ref		Ref
No	1.857 (0.850 - 4.060)	0.120	1.405 (0.423 - 4.670)	0.580
Radiotherapy
Yes	Ref		Ref
No	0.865 (0.411 - 1.820)	0.700	0.591 (0.196 - 1.780)	0.350
Marital status
Married	Ref		Ref
Unmarried	1.860 (1.096 - 3.160)	0.021	3.066 (1.372 - 6.850)	0.006

Table 3. Multivariable Competing Risk Analysis for Cardiovascular Death in Patients With Siewert Type II AEG

Variables

Before PSM, N (%)

After PSM, N (%)

HR (95% CI)

AEG: adenocarcinoma of the esophagogatric junction; CI: confidence interval; HR: hazard ratio; PSM: propensity score matching; RLN: number of removed lymph nodes.

Age

≤ 56

Ref

56 - 75

2.149 (0.986 - 4.680)

0.054

1.477 (0.594 - 3.670)

0.400

> 75

3.298 (1.294 - 8.410)

0.012

3.389 (1.124 - 10.220)

0.030

Sex

Male

Ref

Female

0.884 (0.452 - 1.730)

0.720

0.915 (0.408 - 2.050)

0.830

Race

White

Ref

Black

1.983 (0.899 - 4.370)

0.090

3.274 (1.398 - 7.670)

0.006

Other

1.430 (0.616 - 3.320)

0.410

1.412 (0.428 - 4.660)

0.570

Grade

Ref

0.394 (0.139 - 1.110)

0.079

0.702 (0.140 - 3.520)

0.670

0.667 (0.244 - 1.820)

0.430

0.764 (0.153 - 3.820)

0.740

0.645 (0.072 - 5.760)

0.700

1.652 (0.132 - 20.700)

0.700

T stage

Ref

0.817 (0.308 - 2.170)

0.690

0.987 (0.246 - 3.960)

0.990

0.772 (0.338 - 1.770)

0.540

0.927 (0.286 - 3.000)

0.900

0.628 (0.165 - 2.390)

0.490

0.796 (0.151 - 4.200)

0.790

N stage

Ref

1.520 (0.684 - 3.380)

0.300

1.288 (0.448 - 3.700)

0.640

1.209 (0.461 - 3.170)

0.700

2.095 (0.685 - 6.410)

0.190

1.870 (0.773 - 4.530)

0.170

2.310 (0.847 - 6.300)

0.100

RLN

≤ 10

Ref

10 - 16

0.751 (0.370 - 1.530)

0.430

0.628 (0.245 - 1.610)

0.330

> 16

0.850 (0.446 - 1.620)

0.620

0.705 (0.316 - 1.570)

0.390

Tumor size

≤ 19

Ref

19 - 44

2.227 (0.914 - 5.430)

0.078

1.925 (0.556 - 6.670)

0.300

> 44

1.755 (0.677 - 4.550)

0.250

1.207 (0.319 - 4.560)

0.780

Chemotherapy

Yes

Ref

1.857 (0.850 - 4.060)

0.120

1.405 (0.423 - 4.670)

0.580

Radiotherapy

Yes

Ref

0.865 (0.411 - 1.820)

0.700

0.591 (0.196 - 1.780)

0.350

Marital status

Married

Ref

Unmarried

1.860 (1.096 - 3.160)

0.021

3.066 (1.372 - 6.850)

0.006