Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York.
Cancer. 2013 Sep 1;119(17):3156-61. doi: 10.1002/cncr.28099. Epub 2013 May 29.
Signet ring cell esophageal adenocarcinoma histology has been difficult to study in single institution series because of its relative rarity, yet has an anecdotal reputation for poor prognosis. The Surveillance, Epidemiology, and End Results (SEER) database was examined to assess the prognostic implications of this esophageal adenocarcinoma subtype.
All patients with esophageal adenocarcinoma in the SEER database from 2004 to 2009 were included. Univariate and multivariate analyses examining the relationship of signet ring cell histology with overall survival were performed in all patients, as well as those undergoing surgical resection.
A total of 596 of 11,825 (5%) study patients had signet ring cell histology. Patients with signet ring cell histology were similar in age, race, and sex distribution, but had a higher grade (P < .001) and higher stage (P < .001) at diagnosis. In both the all-patient group as well as those undergoing surgical resection, univariate analyses showed a worse survival in patients with signet ring cell esophageal cancer (hazard ratio [HR] = 1.24; 95% confidence interval [CI] = 1.13-1.36 and HR = 1.57; 95% CI = 1.29-1.93, respectively). In multivariate analyses adjusting for covariates, patients with signet ring cell cancer had a worse prognosis than those without (HR = 1.18; 95% CI = 1.07-1.30). In surgically resected patients, this remained a trend, but did not reach statistical significance (HR = 1.16; 95% CI = 0.94-1.42).
This large study of esophageal adenocarcinoma confirms the clinical impression that signet ring cell variant of adenocarcinoma is associated with an advanced stage at presentation and a worse prognosis independent of stage of presentation.
由于其相对罕见，因此在单机构系列中很难研究印戒细胞食管腺癌组织学，但它有预后不良的传闻。本研究通过检查监测、流行病学和最终结果（SEER）数据库来评估这种食管腺癌亚型的预后意义。
纳入 SEER 数据库中 2004 年至 2009 年间所有食管腺癌患者。对所有患者以及接受手术切除的患者进行单变量和多变量分析，以检查印戒细胞组织学与总生存率的关系。
在 11825 名研究患者中，共有 596 名（5%）患者具有印戒细胞组织学。具有印戒细胞组织学的患者在年龄、种族和性别分布上相似，但在诊断时具有更高的分级（P<0.001）和更高的分期（P<0.001）。在所有患者组以及接受手术切除的患者组中，单变量分析显示印戒细胞食管癌患者的生存情况更差（风险比 [HR] = 1.24；95%置信区间 [CI] = 1.13-1.36 和 HR = 1.57；95%CI = 1.29-1.93）。在调整协变量的多变量分析中，具有印戒细胞癌的患者比没有印戒细胞癌的患者预后更差（HR = 1.18；95%CI = 1.07-1.30）。在接受手术切除的患者中，这仍然是一种趋势，但未达到统计学意义（HR = 1.16；95%CI = 0.94-1.42）。
这项关于食管腺癌的大型研究证实了临床印象，即腺癌的印戒细胞变体与晚期表现和独立于表现阶段的预后不良相关。
