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Erschienen in: Annals of Surgical Oncology 5/2014

01.05.2014 | Thoracic Oncology

Is Preoperative Chemotherapy Followed by Surgery the Appropriate Treatment for Signet Ring Cell Containing Adenocarcinomas of the Esophagogastric Junction and Stomach?

verfasst von: Ulrike Heger, MD, Susanne Blank, MD, Christiane Wiecha, MS, Rupert Langer, MD, Wilko Weichert, MD, Florian Lordick, MD, Thomas Bruckner, PhD, Martin Dobritz, MD, Maria Burian, MD, Christoph Springfeld, MD, PhD, Lars Grenacher, MD, Jörg-Rüdiger Siewert, MD, Markus Büchler, MD, Katja Ott, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 5/2014

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Background

Recent data suggest primary resection as the preferable approach in patients with signet ring cell gastric cancer (SRC). The aim of our retrospective exploratory study was to evaluate the influence of SRC on prognosis and response in esophagogastric adenocarcinoma treated with neoadjuvant chemotherapy.

Methods

A total of 723 locally advanced esophagogastric adenocarcinomas (cT3/4 N any) documented in a prospective database from two academic centers were classified according to the WHO definition for SRC (more than 50 % SRC) and analyzed for their association with response and prognosis after neoadjuvant treatment.

Results

A total of 235 tumors (32.5 %) contained SRC. Median survival of SRC was 26.3 compared with 46.6 months (p < 0.001) for non-SRC. SRC were significantly associated with female gender, gastric localization, advanced ypT and R1/2 categories, and lower risk of surgical complications and anastomotic leakage (each p < 0.001). Clinical (21.1 vs. 33.7 %, p = 0.001) and histopathological response (less than 10 % residual tumor: 16.3 vs. 28.9 %, p < 0.001) were significantly less frequent in SRC. Clinical response (p = 0.003) and complete histopathological response (pCR) (3.4 %) (p = 0.003) were associated with improved prognosis in SRC. Clinical response, surgical complications, ypTN categories, but not SRC were independent prognostic factors in forward Cox regression analysis in R0 resected patients. Risk of peritoneal carcinomatosis was increased (p < 0.001), while local (p = 0.015) and distant metastases (p = 0.02) were less frequent than in non-SRC.

Conclusions

Prognosis of SRC is unfavorable. Although response to neoadjuvant chemotherapy is rare in SRC, it is associated with improved outcome. Thus, chemotherapy might not generally be abandoned in SRC. A stratification based on SRC should be included in clinical trials.
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Metadaten
Titel
Is Preoperative Chemotherapy Followed by Surgery the Appropriate Treatment for Signet Ring Cell Containing Adenocarcinomas of the Esophagogastric Junction and Stomach?
verfasst von
Ulrike Heger, MD
Susanne Blank, MD
Christiane Wiecha, MS
Rupert Langer, MD
Wilko Weichert, MD
Florian Lordick, MD
Thomas Bruckner, PhD
Martin Dobritz, MD
Maria Burian, MD
Christoph Springfeld, MD, PhD
Lars Grenacher, MD
Jörg-Rüdiger Siewert, MD
Markus Büchler, MD
Katja Ott, MD
Publikationsdatum
01.05.2014
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 5/2014
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3462-z

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Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.