Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: A retrospective, propensity score-matched study

Li, Yang; Ma, Fuhai; Xue, Liyan; Tian, Yantao

doi:10.3748/wjg.v26.i8.818

Cited by 27 publications

(32 citation statements)

References 19 publications

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“…9 Piessen et al also pointed out that preoperative chemotherapy was a negative factor for survival (HR=1.25, 95% CI: 0.97, 1.59) among 499 patients. 12 Similar results were obtained in the preoperative chemotherapy studies by Voron et al and Li et al 6,45 However, Heger claimed that there were positive and protective effects of preoperative chemotherapy on GSRC patients (HR=0.572, 95% CI: 0.353, 0.929). 14 Preoperative chemotherapy as an optional treatment for advanced GSRC is disputed for several reasons such as chemoresistance and cancer progression during the preoperative regimen.…”

Section: Preoperative Chemotherapysupporting

confidence: 66%

“…44 Additionally, postoperative chemotherapy did not show a positive impact on survival in the 144 GSRC patients from Li's study (HR=0.654, 95% CI: 0.271, 1.581). 45 It appears that only Shi et al suggested that a selected group of stage IV GSRC patients benefited from postoperative chemotherapy (HR = 0.61, 95% CI: 0.51-0.73). 46 Most studies showed a rare survival benefit in GSRC patients, although positive trends could be obtained with postoperative chemotherapy.…”

Section: Postoperative Chemotherapymentioning

confidence: 99%

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Gastric Signet Ring Cell Carcinoma: Current Management and Future Challenges

Zhu

et al. 2020

CMAR

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Recent advances in the epidemiology, pathology, molecular mechanisms, and combined modality therapy (CMT) fields have shown that gastric signet ring cell carcinoma (GSRC) should be considered a distinct cancerous entity. Clinical management of this cancer is challenging, with chemoradioresistance and poor outcomes in advanced stages. Pathological and molecular sets of GSRC demonstrate different features of poor cohesion and differentiation according to the WHO, Japanese Gastric Cancer Association, and Laurén classifications. These features also result in poor response to adjuvant and neoadjuvant chemoradiotherapy. Certain studies of GSRC showed the disputed effectiveness of hyperthermic intraperitoneal chemotherapy and immunotherapy. Our aim was to discuss how an improved understanding of these therapeutic benefits may provide better treatment selection for patients, and therefore improve survival. The challenges in the new understanding of GSRC in routine practice and pathology, and the current limitations of treatment will also be discussed.

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Section: Preoperative Chemotherapysupporting

confidence: 66%

Section: Postoperative Chemotherapymentioning

confidence: 99%

Gastric Signet Ring Cell Carcinoma: Current Management and Future Challenges

Zhu

et al. 2020

CMAR

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“…Several studies have looked at the effects of SRCC histology on therapeutic interventions. Neoadjuvant chemotherapy provided no survival benefit in patients with locally advanced gastric SRCC [ 35 ]. Esophageal SRCC predicts a poor response to preoperative chemoradiation, with no survival benefit from neoadjuvant treatment even if downstaging occurs [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Signet Ring Cell Adenocarcinomas

Benesch

Mathieson

2020

Cancers

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Signet ring cell adenocarcinomas (SRCCs) are a rare histological subtype of adenocarcinomas with a poor prognosis, typically due to advanced disease at diagnosis. A signet ring cell, mimicking its moniker, contains abundant intracytoplasmic mucin that pushes the nucleus to the periphery. In these cancers, this cell feature comprises more than 50% of the tumor. Despite predilection for the gastrointestinal tract, and in particular the stomach, primary SRCCs are also described in other sites, typically in case reports. This literature, however, lacks a standardized overview of the SRCC disease entity. Using a retrospective cohort approach, we summarize the clinicodemographic and mortality outcomes of SRCCs in thirteen primary sites, comprising 95% of all SRCCs in the Surveillance, Epidemiology, and End Results Program (SEER), a population-level cancer database covering nearly one-third of the United States population. SRCCs general trends compared to matching nonvariant adenocarcinomas are earlier age of onset, with initial presentation favoring higher rates of regional or distant disease presentation and poor tumor differentiation. After multivariable analysis, SRCCs typically have worse overall survivals, but substantial variances exist depending on tumor location. Identifying SRCCs at earlier disease stages is likely the single most important intervention to improving outcomes for these patients.

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“…On the other hand, it might be feasible that in diffuse GC delayed surgery in favor of neoadjuvant chemotherapy, through unknown modifications of tumor microenvironment, could favor tumor cells extravasation and metastasis. Recently, another retrospective analysis suggested an upfront surgery approach highlighting no survival benefit from a pCT strategy in signet-ring cell carcinoma population [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Locally Advanced Gastric Cancer (LAGC): Back to Lauren’s Classification in Pan–Cancer Analysis Era?

Zurlo

Basso

Strippoli

et al. 2020

Cancers

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Background: Guidelines recommend a perioperative approach in patients with stage II/III gastric cancer, but in real-life many patients receive immediate surgery followed by adjuvant chemotherapy (aCT). Although histologic subtypes may have different response to CT, no study has explored the influence of histotype on the efficacy of perioperative CT (pCT) or aCT. Materials and methods: The objective of the study was to evaluate the impact of clinicopathological features and histology (intestinal or diffuse) on survival according to strategy (pCT vs. aCT). The primary endpoint was overall survival (OS) and the secondary endpoint was event-free survival (EFS). Results: Out of 203 patients affected by LAGC, 83 received pCT and 120 aCT. At multivariate, histology and LVI in pCT cohort and positive resection margin in the aCT influenced both OS and EFS. No difference in EFS and OS was observed in relation to strategy. However, in the intestinal-type of pCT cohort survival outcomes were significantly higher compared to the aCT cohort, whereas in the diffuse-type were significantly worse in patients receiving pCT compared to those receiving aCT. Conclusions: Although retrospective and small-sized, this study suggests that the benefit of pCT might be limited to the intestinal-type. This hypothesis needs to be confirmed in prospective series.

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Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: A retrospective, propensity score-matched study

Cited by 27 publications

References 19 publications

<p>Gastric Signet Ring Cell Carcinoma: Current Management and Future Challenges</p>

<p>Gastric Signet Ring Cell Carcinoma: Current Management and Future Challenges</p>

Epidemiology of Signet Ring Cell Adenocarcinomas

Treatment of Locally Advanced Gastric Cancer (LAGC): Back to Lauren’s Classification in Pan–Cancer Analysis Era?

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