Section of Thoracic Surgery, Department of Surgery, New Haven, Connecticut.
Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Ann Thorac Surg. 2020 Jun;109(6):1656-1662. doi: 10.1016/j.athoracsur.2020.01.021. Epub 2020 Feb 25.
Signet ring cell adenocarcinoma (SRC) is a less common histologic variant of esophageal adenocarcinoma (ACA). The low frequency of SRC limits the ability to make data-driven clinical recommendations for these patients.
The National Cancer Database was queried for adult patients with clinical stage I, II, or III adenocarcinoma of the noncervical esophagus diagnosed between 2004 and 2015 and stratified by SRC versus all other ACA variants. Cox proportional hazard regression models were adjusted for patient, tumor, and treatment characteristics. The role of surgery in SRC was evaluated among patients treated with chemoradiation alone versus chemoradiation with esophagectomy.
Of the 681 SRC and 13,543 ACA patients who underwent esophagectomy, no significant differences in age, sex, race, or comorbidities were identified. Patients with SRC were more likely to have high-grade tumors (84% vs 41%, P < .001) and stage III tumors (47% vs 39%, P < .001) compared with patients with ACA. Complete (R0) resection was less common in SRC (81% vs 90%, P < .001). Adjusted 5-year mortality risk from surgery was higher for SRC patients compared with ACA patients (hazard ratio, 1.242; 95% confidence interval, 1.126-1.369; P < .001). Among SRC tumors, chemoradiation with esophagectomy was associated with superior survival (hazard ratio, 0.429; 95% confidence interval, 0.339-0.546; P < .001) compared with chemoradiation alone.
Among surgically managed patients SRC appears to have a worse prognosis than ACA, which may reflect the tendency of SRC tumors to be higher grade and more locally advanced. However SRC histology does not appear to diminish the role of esophagectomy in the management of locoregionally confined esophageal cancer.
印戒细胞腺癌（SRC）是食管腺癌（ACA）较少见的组织学变异型。SRC 的低频率限制了为这些患者提供基于数据的临床建议的能力。
从 2004 年至 2015 年期间，在国家癌症数据库中对临床 I、II 或 III 期非颈段食管腺癌的成年患者进行了查询，并根据 SRC 与所有其他 ACA 变体进行了分层。使用 Cox 比例风险回归模型调整了患者、肿瘤和治疗特征。在单独接受放化疗与放化疗联合食管切除术的患者中，评估了手术在 SRC 中的作用。
在接受食管切除术的 681 例 SRC 和 13543 例 ACA 患者中，年龄、性别、种族或合并症无显著差异。与 ACA 患者相比，SRC 患者更有可能患有高级别肿瘤（84%比 41%，P<.001）和 III 期肿瘤（47%比 39%，P<.001）。SRC 患者完全（R0）切除的比例较低（81%比 90%，P<.001）。与 ACA 患者相比，SRC 患者手术后 5 年死亡率风险更高（风险比，1.242；95%置信区间，1.126-1.369；P<.001）。在 SRC 肿瘤中，与单独放化疗相比，放化疗联合食管切除术与生存获益相关（风险比，0.429；95%置信区间，0.339-0.546；P<.001）。
在接受手术治疗的患者中，SRC 的预后似乎比 ACA 差，这可能反映了 SRC 肿瘤倾向于更高的分级和更局部晚期。然而，SRC 组织学似乎并没有降低食管切除术在局部局限型食管癌治疗中的作用。
