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Neoadjuvant therapy improves outcomes in locally advanced signet-ring-cell containing esophagogastric adenocarcinomas

BackgroundOnly a few studies have analyzed multimodal treatment concepts in the subgroup of signet-ring-cell containing upper gastrointestinal (GI) cancer. Recent retrospective, multicentric data favor primary resection without neoadjuvant chemotherapy for gastric signet-ring-cell containing carcino...

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Main Authors: Heger, Ulrike (Author) , Peters, Leila (Author) , Nienhüser, Henrik (Author) , Blank, Susanne (Author) , Hinz, Ulf (Author) , Haag, Georg Martin (Author) , Ott, Katja (Author) , Ulrich, Alexis (Author) , Büchler, Markus W. (Author) , Schmidt, Thomas (Author)
Format: Article (Journal)
Language:English
Published: 31 May 2018
In: Annals of surgical oncology
Year: 2018, Volume: 25, Issue: 8, Pages: 2418-2427
ISSN:1534-4681
DOI:10.1245/s10434-018-6541-3
Online Access:Verlag, Volltext: https://doi.org/10.1245/s10434-018-6541-3
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Author Notes:Ulrike Heger, Leila Sisic, Henrik Nienhüser, Susanne Blank, Ulf Hinz, Georg Martin Haag, Katja Ott, Alexis Ulrich, Markus W. Büchler, Thomas Schmidt
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Summary:BackgroundOnly a few studies have analyzed multimodal treatment concepts in the subgroup of signet-ring-cell containing upper gastrointestinal (GI) cancer. Recent retrospective, multicentric data favor primary resection without neoadjuvant chemotherapy for gastric signet-ring-cell containing carcinomas (SRCs). We compared the outcomes of primarily resected carcinomas with neoadjuvantly treated, locally advanced esophagogastric SRCs.MethodsA total of 310 patients with esophagogastric SRC-staged cT3/4/Nany/Many from a prospective unicentric database were included in this study; 192 (61.9%) received neoadjuvant therapy (NEO group) and 118 (38.1%) were primarily resected (RES group).ResultsOverall, 128 (41.3%) patients presented with adenocarcinoma of the esophagogastric junction (AEG) and 182 (58.7%) presented with gastric cancer. Neoadjuvant therapy was significantly associated with resection in curative intent (NEO: 91.1%; RES: 75.4%; P = 0.001), improved (y)pT category (P = 0.035), improved (y)pN category (P < 0.001), and R0 resections (curative intent cohort: 76.0% in NEO vs. 60.7% in RES; P = 0.010), among others, but not with postoperative complications. Overall survival was significantly improved by neoadjuvant treatment {median survival 28.5 months (95% confidence interval [CI] 14.4-39.6) vs. RES: 14.9 months (10.6-17.5); P < 0.001}, as well as in subgroups (AEG and gastric tumors, R0-resected patients, and patients with and without relevant comorbidities). Independent prognostic factors were neoadjuvant therapy (hazard ratio [HR] 0.66; P = 0.023), pT4 category (HR 1.71; P = 0.041), pN2 category (HR 1.86; P = 0.013), pN3 category (HR 2.40; P < 0.001), pM1 category (HR 1.95; P = 0.003), age > 70 years (HR 1.79; P = 0.006), gastric localization (HR 0.69; P = 0.032), American Society of Anesthesiologists classification 3/4 (HR 1.71; P = 0.004), and incomplete resection R1/2 (HR 1.6; P = 0.014).ConclusionsOur results demonstrate a survival advantage for advanced-stage esophagogastric SRC patients by neoadjuvant treatment.
Item Description:Gesehen am 23.10.2019
Physical Description:Online Resource
ISSN:1534-4681
DOI:10.1245/s10434-018-6541-3

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