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Signet ring gastric and esophageal adenocarcinomas: characteristics and prognostic implications

Lookup NU author(s): Alexander Phillips, Professor Michael Griffin

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Abstract

© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.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.


Publication metadata

Author(s): Khan N, Donohoe CL, Phillips AW, Griffin SM, Reynolds JV

Publication type: Article

Publication status: Published

Journal: Diseases of the Esophagus

Year: 2020

Volume: 33

Issue: 11

Online publication date: 07/05/2020

Acceptance date: 02/04/2016

ISSN (print): 1120-8694

ISSN (electronic): 1442-2050

Publisher: Oxford University Press

URL: https://doi.org/10.1093/dote/doaa016

DOI: 10.1093/dote/doaa016

PubMed id: 32378712


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