Signet Ring Cells and Efficacy of First-line Chemotherapy in Advanced Gastric or Oesogastric Junction Adenocarcinoma

Lemoine, Nathalie; Adenis, Antoine; Bouché, Olivier; Duhamel, Alain; Heurgué, Alexandra; Leteurtre, Emmanuelle; Amela, Eric Yaovi; Salleron, Julia; Hebbar, Mohamed

doi:10.21873/anticanres.11138

Cited by 22 publications

(24 citation statements)

References 34 publications

(47 reference statements)

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“…In subgroup analysis, 13 of 17 subgroups of metastatic SRCC obtained survival benefit from PG+C compared to PG/C alone, especially for those with only one metastatic site. Some of previous studies suggested that SRCC is less chemo‐sensitive than non‐SRCC cancers, so the value of palliative gastrectomy plus chemotherapy may be even higher in stage IV gastric SRCC than NOS. In addition, several recently published studies proved that improved long‐term survival was observed among stage IV GC patients who underwent conversion surgery (primary tumor resection performed in initially unresectable metastatic cancer after responding to chemotherapy) .…”

Section: Discussionmentioning

confidence: 98%

Survival benefit of palliative gastrectomy followed by chemotherapy in stage IV gastric signet ring cell carcinoma patients: A large population‐based study

et al. 2019

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Background Stage IV gastric signet ring cell carcinoma (SRCC) is a type of malignant gastric cancer (GC) with poorer survival compared to metastatic non‐SRCC gastric cancer (NOS). However, chemotherapy alone was unable to maintain long‐term survival. This study aimed to evaluate survival benefit of palliative gastrectomy plus chemotherapy (PG+C) for metastatic gastric SRCC. Methods We obtained data on gastric cancer patients between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Statistical methods included χ2 tests, Kaplan‐Meier curves, COX models, propensity score matching (PSM) and subgroup analysis. Results Among 27 240 gastric cancer patients included, 4638 (17.03%) were SRCC patients. The proportion of patients with younger age, female gender, poorly differentiated grade and M1 stage was higher in SRCC than in NOS (P < .001). Multivariate analysis revealed that multiple metastatic sites (HR = 1.39, 95% CI: 1.14‐1.69, P = .001) was associated with increased mortality risk in metastatic SRCC. Median survival time was improved in metastatic SRCC receiving PG+C compared to PG/C alone (13 vs 7 months, P < .001). Notably, in subgroup analysis, 13 of 17 groups of metastatic SRCC patients with PG+C had prolonged overall survival compared to chemotherapy alone, especially for those with only one metastatic site (HR = 0.61, 95% CI: 0.51‐0.73, P < .001). Conclusions Our results suggested that there exists at least a selective group of stage IV gastric SRCC patients, who could benefit from palliative gastrectomy followed by chemotherapy compared to chemotherapy alone. Further prospective trials are needed to support our conclusion.

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Section: Discussionmentioning

confidence: 98%

Survival benefit of palliative gastrectomy followed by chemotherapy in stage IV gastric signet ring cell carcinoma patients: A large population‐based study

et al. 2019

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“…41,42 Several studies and retrospective analyses have shown that GSRC cannot benefit from chemotherapy or radiotherapy due to chemoresistance. 6,8,10 Chemotherapy GSRC has the characteristic of chemoresistance which has been confirmed by several studies. However, the effectiveness of chemotherapy for GSRC remains controversial.…”

Section: Adjuvant and Neoadjuvant Treatmentsmentioning

confidence: 74%

“…Lemoine et al reported that advanced GSRC appeared to benefit less from chemotherapy with a median overall survival of 5.6 months compared to 9.4 months for non-GSRC patients. 8 However, triplet chemotherapy with docetaxel-5FU-oxaliplatin (TEFOX) has yielded favorable results among GSRC patients, and appears to be an effective as first-line treatment for advanced GSRC. 41 Effective biological targets need to be explored to improve the survival of GSRC.…”

Section: Management Of Metastatic Gsrc Systemic Chemotherapymentioning

confidence: 99%

“…6 Perioperative adjuvant or neoadjuvant chemoradiotherapy can be used, but many patients continue to develop drug resistance and metastatic disease. [8][9][10] These treatments are associated with limited benefits in overall survival, and median survival in the majority of clinical trials is 12 to 20 months. 9,[11][12][13] Although several prognostic and predictive factors have been investigated, including patient and tumor characteristics, none of these have provided strategies based on the unique biomarkers in GSRC.…”

Section: Introductionmentioning

confidence: 99%

“…Initial trials of CMT in GSRC have produced conflicting results. 8,14,15 In addition to these clinical challenges, it has been increasingly recognized that the poor prognosis of GSRC is closely related to unique biological behaviors. 5,16,17 This review assesses how a better understanding of the CMT and genetic features of GSRC might improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

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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Intensifying supportive care is associated with improved survival in gastric cancer patients with malignant ascites

Karalis,

Ju,

Feig

et al. 2023

Journal of Surgical Oncology

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BackgroundGastric cancer patients with malignant ascites often have poor functional status and malnutrition that preclude receipt of systemic therapies. Thus, these patients have a very poor prognosis. Beginning in 2019, our multidisciplinary gastric cancer disease‐oriented team implemented a more aggressive supportive care plan for gastric cancer patients with malignant ascites. The initiative included measures such as supplemental enteral nutrition, ascites drainage, and initiation of chemotherapy on an inpatient basis. We compared outcomes for gastric cancer patients who presented with synchronous malignant ascites treated before and after the implementation of the care plan.MethodsWe performed a retrospective review of our institutional database to identify patients diagnosed with gastric adenocarcinoma and synchronous malignant ascites between 2010 and 2022. We compared overall survival (OS) between patients diagnosed from 2010 to 2018, which will be referred to as the historical control era and patients diagnosed from 2019 to 2022, which will be called the aggressive supportive care era.ResultsFifty‐four patients were included in our analysis; 31 patients were treated in the historical control time frame, and 23 patients were treated during the aggressive supportive care era. Demographic, clinical, and pathologic characteristics were similar between groups. 3% of historical controls received supplemental tube feeds at diagnosis as compared to 30% of the aggressive supportive care cohort (p < 0.01). 3% of historical controls received their first cycle of chemotherapy in the inpatient setting versus 39% of patients treated during the aggressive supportive care era (p < 0.01). The median number of chemotherapy cycles received was 5 among historical controls and 9.5 among aggressive supportive care era patients (p = 0.02). There was no difference in the number of days spent as an inpatient between the two groups. The median OS for historical control patients was 5.4 months as compared with 10.4 months for patients treated during aggressive supportive care era (p = 0.04).ConclusionsGastric cancer patients with synchronous malignant ascites treated during a timeframe when our multidisciplinary team implemented more aggressive supportive care measures had improved OS as compared with historic controls. Our results suggest that aggressive supportive measures for these patients with highly challenging clinical issues and poor prognosis can prolong survival. Specifically, initiation of chemotherapy in the inpatient setting and supplemental nutrition should be considered for patients at high risk for treatment intolerance.

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Signet Ring Cells and Efficacy of First-line Chemotherapy in Advanced Gastric or Oesogastric Junction Adenocarcinoma

Abstract: Patients with advanced SRC adenocarcinomas seemed to benefit less from chemotherapy, whereas the presence of SRC was not an independent survival prognostic factor.

Cited by 22 publications

References 34 publications

Survival benefit of palliative gastrectomy followed by chemotherapy in stage IV gastric signet ring cell carcinoma patients: A large population‐based study

Survival benefit of palliative gastrectomy followed by chemotherapy in stage IV gastric signet ring cell carcinoma patients: A large population‐based study

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

Intensifying supportive care is associated with improved survival in gastric cancer patients with malignant ascites

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