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Neoadjuvant Therapy Improves Outcomes in Locally Advanced Signet-Ring-Cell Containing Esophagogastric Adenocarcinomas

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Only 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.

Methods

A 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).

Results

Overall, 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).

Conclusions

Our results demonstrate a survival advantage for advanced-stage esophagogastric SRC patients by neoadjuvant treatment.

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Funding

Leila Sisic received funding through a grant from the Faculty of Medicine, University of Heidelberg, however this has no relationship to the submitted work.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany

    Ulrike Heger MD, Leila Sisic MD, Henrik Nienhüser MD, Susanne Blank MD, Ulf Hinz MSc, Alexis Ulrich MD, Markus W. Büchler MD & Thomas Schmidt MD, PhD

  2. National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany

    Georg Martin Haag MD

  3. Department of Surgery, RoMed Klinikum, Rosenheim, Germany

    Katja Ott MD

Authors
  1. Ulrike Heger MD
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  2. Leila Sisic MD
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  3. Henrik Nienhüser MD
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  6. Georg Martin Haag MD
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  10. Thomas Schmidt MD, PhD
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Correspondence to Thomas Schmidt MD, PhD.

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Heger, U., Sisic, L., Nienhüser, H. et al. Neoadjuvant Therapy Improves Outcomes in Locally Advanced Signet-Ring-Cell Containing Esophagogastric Adenocarcinomas. Ann Surg Oncol 25, 2418–2427 (2018). https://doi.org/10.1245/s10434-018-6541-3

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  • DOI: https://doi.org/10.1245/s10434-018-6541-3

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