印戒细胞组织学在切除的胃腺癌中的预后价值
The Prognostic Value of Signet-Ring Cell Histology in Resected Gastric Adenocarcinoma.
作者信息
Postlewait Lauren M, Squires Malcolm H, Kooby David A, Poultsides George A, Weber Sharon M, Bloomston Mark, Fields Ryan C, Pawlik Timothy M, Votanopoulos Konstantinos I, Schmidt Carl R, Ejaz Aslam, Acher Alexandra W, Worhunsky David J, Saunders Neil, Swords Douglas, Jin Linda X, Cho Clifford S, Winslow Emily R, Cardona Kenneth, Staley Charles A, Maithel Shishir K
机构信息
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
出版信息
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S832-9. doi: 10.1245/s10434-015-4724-8. Epub 2015 Jul 9.
BACKGROUND
Conflicting data exist on the prognostic implication of signet-ring cell (SRC) histology in gastric adenocarcinoma (GAC).
METHODS
All patients who underwent curative-intent resection of GAC from the seven institutions of the U.S. Gastric Cancer Collaborative between 2000 and 2012 were included. Primary end points were recurrence-free survival (RFS) and overall survival (OS). Stage-specific analyses were performed.
RESULTS
A total of 768 patients met the inclusion criteria. SRC was present in 40.6 % of patients and was associated with female sex (52.9 vs. 38.6 %; p < 0.001), younger age (61 vs. 67 years; p < 0.001), poor differentiation (94.8 vs. 50.3 %; p < 0.001), perineural invasion (PNI) (41.4 vs. 23 %; p < 0.001), microscopically positive resection margins (R1, 24.7 vs. 8.6 %; p < 0.001), distal location (82.2 vs. 70.1 %; p < 0.001), receipt of adjuvant therapy (63 vs. 51.2 %; p = 0.002), and more advanced stage (stage 3: 55.2 vs. 36.5 %; p < 0.001). SRC was associated with earlier recurrence (56.7 months vs. median not reached; p = 0.009) and decreased OS (33.7 vs. 46.6 months; p = 0.011). When accounting for other adverse pathologic features, PNI (hazard ratio [HR] 1.57; p = 0.016) and higher stage (HR 2.64; p < 0.001) were associated with decreased RFS, but SRC was not. Although PNI (HR 1.52; p = 0.007), higher stage (HR 2.11; p < 0.001), greater size (HR 1.05; p = 0.016), and adjuvant therapy (HR 0.50; p < 0.001) were associated with OS, SRC was not. Similarly, when accounting for adverse pathologic factors on multivariate analysis, stage-specific analyses showed no association between SRC and RFS or OS.
CONCLUSIONS
SRC histology is associated with adverse pathologic features including poor differentiation, higher stage, and microscopically positive resection margins but is not independently associated with reduced RFS or OS. Identification of signet-ring histology during preoperative evaluation should not, in isolation, dictate treatment strategy.
背景
关于胃腺癌（GAC）中印戒细胞（SRC）组织学的预后意义，存在相互矛盾的数据。
方法
纳入了2000年至2012年间在美国胃癌协作组7家机构接受GAC根治性切除的所有患者。主要终点是无复发生存期（RFS）和总生存期（OS）。进行了分期特异性分析。
结果
共有768例患者符合纳入标准。40.6%的患者存在SRC，且与女性（52.9%对38.6%；p<0.001）、较年轻年龄（61岁对67岁；p<0.001）、低分化（94.8%对50.3%；p<0.001）、神经周围侵犯（PNI）（41.4%对23%；p<0.001）、显微镜下切缘阳性（R1，24.7%对8.6%；p<0.001）、远端部位（82.2%对70.1%；p<0.001）、接受辅助治疗（63%对51.2%；p=0.002）以及更晚期别（3期：55.2%对36.5%；p<0.001）相关。SRC与较早复发（56.7个月对未达到中位数；p=0.009）和OS降低（33.7个月对46.6个月；p=0.011）相关。当考虑其他不良病理特征时，PNI（风险比[HR]1.57；p=0.016）和较高级别（HR 2.64；p<0.001）与RFS降低相关，但SRC无关。尽管PNI（HR 1.52；p=0.007）、较高级别（HR 2.11；p<0.001）、更大尺寸（HR 1.05；p=0.016）和辅助治疗（HR 0.50；p<0.001）与OS相关，但SRC无关。同样，在多变量分析中考虑不良病理因素时，分期特异性分析显示SRC与RFS或OS之间无关联。
结论
SRC组织学与包括低分化、较高级别和显微镜下切缘阳性在内的不良病理特征相关，但与RFS或OS降低无独立关联。术前评估中单独识别印戒组织学不应决定治疗策略。
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