Survival predictors associated with signet ring cell carcinoma of the esophagus (SRCCE): A population-based retrospective cohort study

Development and validation of nomograms based on the SEER database for the risk factors and prognosis of distant metastasis in gastric signet ring cell carcinoma

Poor prognosis in patients with distant metastasis of gastric signet ring cell carcinoma (GSRC), and there are few studies on the development and validation of the diagnosis and prognosis of distant metastasis of GSRC. The Surveillance, Epidemiology, and End Results database was used to identify patients with GSRC from 2004 to 2019. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for distant metastasis of GSRC, while univariate and multivariate Cox proportional hazard regression analysis were used to determine independent prognostic factors for patients with distant metastasis of GSRC. Two nomograms were established, and model performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis. A total of 9703 cases with GSRC were enrolled, among which 2307 cases (23.78%) were diagnosed with distant metastasis at the time of diagnosis. Independent risk factors for distant metastasis included age, race, and T stage. Independent prognostic factors included T stage, chemotherapy, and surgery. The receiver operating characteristic curve, calibration curve, decision curve analysis curve, and Kaplan-Meier survival curve of the training set and validation set confirmed that the 2 nomograms could accurately predict the occurrence and prognosis of distant metastasis in GSRC. Two nomograms can serve as effective prediction tools for predicting distant metastasis in GSRC patients and the prognosis of patients with distant metastasis. They have a certain clinical reference value.

Clinicopathological Features and Prognostic-Related Risk Factors of Gastric Signet Ring Cell Carcinoma: A Meta-Analysis

Background

Gastric signet ring cell carcinoma (SRCC) has shown a growth growing trend worldwide, but its clinicopathological features and prognostic-related risk factors have not been systematically studied. This systematic review was devoted to this.

Method

PubMed, Embase, Cochrane Library, and Web of Science databases were retrieved, and retrospective cohort studies comparing clinicopathological features and related risk factors in SRCC patients were included.

Results

In SRCC patient population, males were more than females (male, OR = 1.38, 95% CI: 1.20-1.60); N3 patients were more than N0-2 patients (N0-2, OR = 3.19, 95% CI: 1.98-5.15); M1 patients were more than M0 patients (M0, OR = 3.30, 95% CI: 1.88-5.80); patients with tumor > 5 cm were more than those with tumor (≤5 cm, OR = 7.36, 95% CI: 1.33-40.60). Patients with age < 60 years (age ≥ 60 years, OR = 1.03, 95% CI: 1.01-1.05), lymphatic vessel invasion (no, OR = 1.74, 95% CI: 1.03-2.45), T2 (T1, OR = 1.17, 95% CI: 1.07-1.28) and T4 (T1, OR = 2.55, 95% CI: 2.30-2.81) stages, and N1 (N0, OR = 1.73, 95% CI: 1.08-2.38), N2 (N0, OR = 2.24, 95% CI: 1.12-3.36), and N3 (N0, OR = 3.45, 95% CI: 1.58-5.32) stages had higher hazard ratio (HR).

Conclusion

SRCC may occur frequently in male. Age, lymphatic vessel invasion, TN, and M stage may be risk factors for poor prognoses of SRCC patients.

Comparative analysis of clinical, treatment, and survival characteristics of signet ring cell and adenocarcinoma of esophagus

Background

Signet ring cell carcinoma (SRC) is a rare pathological subtype of mucinous adenocarcinoma (AC). Clinical features, prognosis, and especially treatment methods between SRC and AC of the esophagus remain controversial. Thus, we conducted this study to explore the differences in clinicopathological characteristics and treatment modalities between SRC and AC of the esophagus.

Methods

A retrospective cohort study based on the Surveillance, Epidemiology, and End Results (SEER) program database was conducted. Patients diagnosed with SRC or AC not otherwise specified (NOS) were selected between 2004 and 2018. We investigated the prognosis of SRC and AC in terms of overall survival (OS). A subgroup analysis was performed according to the stage and different treatment methods.

Results

A total of 24,987 patients were enrolled, including 1,147 with SRC and 23,840 with AC. In the multivariate Cox analysis of the whole cohort, SRC, tumor site, differentiation, metastases, American Joint Committee on Cancer (AJCC) 6th edition staging, treatment, tumor size, lymph nodes examined, and positive lymph nodes were independent risk factors. The results of the subgroup analysis showed that surgery alone was associated with better OS for AC at the early stage, but was not significantly different for SRC (P=0.896). Surgery plus adjuvant therapy was the best treatment for SRC and AC at the late stage. In the multivariate Cox analysis, the treatment of surgery plus adjuvant therapy had a tendency towards better OS at the early stage [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.39-1.1, P=0.08].

Conclusions

SRC is an independent risk factor, with a higher grade of differentiation, later stage, larger tumor size, more positive lymph nodes, and poorer prognosis compared with AC. Surgery plus adjuvant therapy seems to be useful for SRC at the early stage, but further research is needed.

Nomogram for predicting the overall survival of the patients with oesophageal signet ring cell carcinoma

Background

The purpose of this study was to explore the prognostic factors of oesophageal signet ring cell (SRC) carcinoma and to construct a nomogram for predicting the outcome of SRC carcinoma of oesophagus.

Methods

A total of 968 cases of oesophageal SRC carcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2016. Cases were divided into training cohort and validation cohort. Univariate and multivariable Cox analyses was performed to select the predictors of overall survival (OS for the nomogram. The performance of nomogram was validated with Harrell’s concordance index (C-index), calibration curves and decision curve analysis (DCA).

Results

The 1- and 5-year OS in the training cohort were 0.446 and 0.146, respectively, and the 1- and 5-year OS in the validation cohort were 0.459 and 0.138. The independent prognostic factors for establishing the nomogram were marital status, invasion of the surrounding tissue, lymph node metastasis, distant metastasis, surgery and chemotherapy. The Harrell’s c-index value of the training cohort and validation cohort were 0.723 and 0.708. In the calibration curves, the predicted survival probability and the actual survival probability have a considerable consistency. DCA indicated the favourable potential clinical utility of the nomogram.

Conclusions

A nomogram to predict the OS of patients with oesophageal SRC carcinoma was established. The validation of the nomogram fully demonstrates its great performance.

Gastric Signet Ring Cell Carcinoma: Current Management and Future Challenges

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.

Signet Ring Cell Histology Confers Worse Overall Survival in Treated Esophageal Adenocarcinoma

BACKGROUND

Signet ring cell (SRC) histology is regarded as a poor prognostic indicator for esophageal cancer. The objectives of this study were to understand the clinical presentation and stage-specific survival outcomes of patients with SRC and nonsignet adenocarcinoma (AC).

METHODS

From 2004 to 2016, 140,324 patients were diagnosed with esophageal and gastroesophageal junction cancers in the National Cancer Database. Demographics, tumor variables, and treatment were studied. Overall survival was shown by the Kaplan-Meier method, and random survival forest identified important predictors.

RESULTS

SRC patients (N = 3825) comprised roughly 3% of esophageal cancers per year. SRC patients were less likely to present at early stage disease (cStage I: 10.2% vs 17.8% for AC; P < .001) and more likely to have pathologic upstaging (28% vs 16%, P < .001) and less pathologic downstaging after neoadjuvant therapy (36% vs 48%, P < .001). More SRC patients had positive margins after resection (15% vs 6.0%, P < .001). In a stage-matched comparison median survival for SRC patients was worse than for AC patients (cStage I: 60 vs 113 months; cStage II: 31 vs 40 months; cStage III: 22 vs 30 months). Clinical tumor and nodal stage, chemotherapy sequence, and age were important predictors of survival.

CONCLUSIONS

SRC patients had worse survival than their AC counterparts. Worse biology and higher rates of incomplete resection in SRC should steer patients away from undergoing limited resection, such as endoscopic submucosal dissection, even when identified at very early stages. In future esophageal cancer staging iterations, separating SRC from AC appears to be indicated because of their different clinical behavior and response to therapy.