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. 2019 Aug;26(8):2375-2384.
doi: 10.1245/s10434-019-07322-x. Epub 2019 Apr 2.

The Impact of Signet Ring Cell Differentiation on Outcome in Patients with Esophageal and Gastroesophageal Junction Adenocarcinoma

Sander J M van Hootegem  1 , B Mark Smithers  2   3   4 , David C Gotley  2   3 , Sandra Brosda  5 , Iain G Thomson  2   3 , Janine M Thomas  2   4 , Michael Gartside  5 , Jan J B van Lanschot  6 , Sjoerd M Lagarde  6 , Bas P L Wijnhoven  6 , Andrew P Barbour  2   3   5
Affiliations

The Impact of Signet Ring Cell Differentiation on Outcome in Patients with Esophageal and Gastroesophageal Junction Adenocarcinoma

Sander J M van Hootegem et al. Ann Surg Oncol. 2019 Aug.

Abstract

Background: Little is known about the association between signet ring cell (SRC) differentiation and response to neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) in patients with esophageal and junctional adenocarcinoma (EAC). We aimed to assess if SRC differentiation is associated with survival and response to nCT or nCRT in patients with EAC.

Methods: Patients who underwent nCT and nCRT followed by surgery for EAC from 2000 until 2016 were identified from two institutional prospectively maintained databases. The pretreatment biopsy report or surgical resection specimen was used to differentiate patients into an SRC or non-SRC group.

Results: Overall, 129 (19%) of 689 patients included had SRCs (nCT: n = 64; nCRT: n = 65). The SRC group had a more advanced ypT stage (p = 0.003), a higher number of positive lymph nodes in the resection specimen {median (interquartile range [IQR]) 2 [0-5] vs. 1 [0-3]; p = 0.002} and a higher rate of R1/R2 resections (19.4% vs. 12%; p = 0.026). SRC differentiation was not an independent prognostic factor for overall survival (OS) or disease-free survival (DFS). Following nCT, the SRC group had significantly shorter DFS (median [IQR] 12 [5-50] vs. 23 [8-164]; p = 0.013), but not OS, compared with the non-SRC group. In contrast, no differences according to SRC status for OS or DFS were found in patients who underwent nCRT.

Conclusions: SRC differentiation was not independently associated with worse OS in patients with EAC who underwent neoadjuvant therapy and surgery. However, nCRT was associated with greater tumor downstaging and better DFS.

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Conflict of interest statement

Sander J.M. van Hootegem, B. Mark Smithers, David C. Gotley, Sandra Brosda, Iain G. Thomson, Janine M. Thomas, Michael Gartside, Jan J.B. van Lanschot, Sjoerd M. Lagarde, Bas P.L. Wijnhoven, and Andrew P. Barbour declare they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Survival curves according to SRC status. a Overall survival; p = 0.081; b overall survival in the nCT group; p = 0.076; c overall survival in the nCRT group; p = 0.541; d disease-free survival; p = 0.081; e disease-free survival in the nCT group; p = 0.013; f disease-free survival in the nCRT group; p = 0.914; g locoregional recurrence-free survival in the nCT group; p = 0.003; h distant recurrence-free survival in the nCT group; p = 0.185. SRC signet ring cell, nCRT neoadjuvant chemoradiotherapy, nCT neoadjuvant chemotherapy
Fig. 1
Fig. 1
Survival curves according to SRC status. a Overall survival; p = 0.081; b overall survival in the nCT group; p = 0.076; c overall survival in the nCRT group; p = 0.541; d disease-free survival; p = 0.081; e disease-free survival in the nCT group; p = 0.013; f disease-free survival in the nCRT group; p = 0.914; g locoregional recurrence-free survival in the nCT group; p = 0.003; h distant recurrence-free survival in the nCT group; p = 0.185. SRC signet ring cell, nCRT neoadjuvant chemoradiotherapy, nCT neoadjuvant chemotherapy
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References

    1. Donahue JM, Nichols FC, Li Z, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg. 2009;87(2):392–398. doi: 10.1016/j.athoracsur.2008.11.001. - DOI - PMC - PubMed
    1. Petrelli F, Tomasello G, Barni S. Surrogate end-points for overall survival in 22 neoadjuvant trials of gastro-oesophageal cancers. Eur J Cancer. 2017;76:8–16. doi: 10.1016/j.ejca.2017.01.032. - DOI - PubMed
    1. Messager M, Lefevre JH, Pichot-Delahaye V, et al. The impact of perioperative chemotherapy on survival in patients with gastric signet ring cell adenocarcinoma: a multicenter comparative study. Ann Surg. 2011;254(5):684–693. doi: 10.1097/SLA.0b013e3182352647. - DOI - PubMed
    1. Piessen G, Messager M, Leteurtre E, Jean-Pierre T, Mariette C. Signet ring cell histology is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of tumoral clinical presentation. Ann Surg. 2009;250(6):878–887. doi: 10.1097/SLA.0b013e3181b21c7b. - DOI - PubMed
    1. Heger U, Blank S, Wiecha C, et al. Is preoperative chemotherapy followed by surgery the appropriate treatment for signet ring cell containing adenocarcinomas of the esophagogastric junction and stomach? Ann Surg Oncol. 2014;21(5):1739–1748. doi: 10.1245/s10434-013-3462-z. - DOI - PubMed

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