Summary
Controversy exists as to the relevance of the signet ring carcinoma (SRC) histological subtype of esophagogastric adenocarcinoma to long-term prognosis, with some studies reporting a worsened oncological outcome and others no clinically relevant impact. A retrospective analysis of outcomes of patients who underwent surgery with curative intent in two high-volume centers (2000–2015) was undertaken. Tumors were analyzed according to location (esophageal, junctional or gastric). Propensity score matching (PSM) analysis was used to match patients with signet ring histology to those without (195 SRC vs. 573 non-SRC), based on age, tumor location, use of neoadjuvant and adjuvant chemotherapy and pathological stage. A total of 2,500 patients with esophagogastric adenocarcinomas were treated, of whom 198 (7.9%) had signet ring histology. Signet ring tumors were more likely to have positive lymph nodes at pathological analysis (59% vs. 50%, P = 0.009). The 5-year survival rate for patients with early signet ring tumors (Stage 0/I/IIa) was 65% versus 85% for other early cancers (P < 0.003). Patients with esophageal signet ring tumors had a particularly poor prognosis with 23% 2-year survival and none alive at 5 years. With PSM, overall survival (OS) was significantly poorer in the signet ring group (44.3 ± 8.6 vs. 59.8 ± 8.5 months, 5-year OS 41% vs. 50%, P = 0.027). Signet ring cells within esophagogastric adenocarcinoma are associated with a poorer prognosis. Genomic studies to identify the composition of such tumors as well as identify strategies to improve treatment for this subtype are warranted.
Background
Controversy exists as to the relevance of the signet ring carcinoma (SRC) histological subtype of oesophagogastric adenocarcinoma to long-term prognosis. Some studies report a favourable prognosis while others report the contrary.
Methods
Retrospective analysis of outcomes of patients who underwent surgery with curative intent in two high volume centres (2000–15). Tumours were analysed according to location (oesophageal, junctional or stomach). Propensity score match (PSM) analysis was used to match patients with signet ring histology to those with oesophagogastric adenocarcinomas based on age, tumour location, use of neoadjuvant and adjuvant chemotherapy and pathological stage.
Results
A total of 2500 patients with oesophagogastric adenocarcinomas were treated, of whom 198 (7.9%) had signet ring histology. SRCs were more likely to have positive lymph nodes at pathological analysis (59% versus 50%, P = 0.009). Patients with oesophageal SRCs (n = 10) had a particularly poor prognosis with 23% 2 year survival and none alive at 5 years. The five year survival rate for patients with early SRC tumours (Stage 0/I/IIa) was 65% versus 85% for other early cancers (P < 0.003). PSM was used to match 195 of the SRC cases to 573 controls based on stage and treatment. Overall survival was significantly poorer in the SRC group (44.3 ± 8.6 versus 59.8 ± 8.5 months, 5 year OS 41% v 50%, P = 0.027).
Conclusion
Patients with the SRC variant of oesophagogastric cancer have a poorer prognosis. Genomic studies to identify the composition of such tumours as well as identify strategies to improve treatment for this subtype are warranted.
Disclosure
All authors have declared no conflicts of interest.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.