Corsini Erin M, Foo Wai Chin, Mitchell Kyle G, Zhou Nicolas, Maru Dipen M, Ajani Jaffer A, Hofstetter Wayne L, Correa Arlene M, Antonoff Mara B, Lin Steven H, Mehran Reza J, Rajaram Ravi, Rice David C, Roth Jack A, Sepesi Boris, Swisher Stephen G, Vaporciyan Ara A, Walsh Garrett L
Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex.
J Thorac Cardiovasc Surg. 2021 Nov;162(5):1404-1412.e2. doi: 10.1016/j.jtcvs.2020.08.108. Epub 2020 Sep 5.
Multiple investigations have shown inferior outcomes for esophageal cancer patients with signet ring cell (SRC) histology. Traditionally, SRC adenocarcinoma has been defined by ≥50% of the tumor composed of SRC. We hypothesized that patients with SRC even <50% would show resistance to standard multimodality therapy with poorer long-term outcomes.
Patients treated with trimodality therapy for adenocarcinoma from 2006 to 2018 were evaluated for SRC on pretreatment biopsy specimens. Available hematoxylin and eosin slides containing SRC tumors were re-reviewed by an esophageal pathologist to quantify the percent composition of SRC.
SRC histology was identified on at least 1 pathologic specimen in 106 of 819 (13%) patients. Rates of pathologic complete response (pCR) among usual-type and SRC tumors were 25% (177/713) and 10% (11/106), respectively (P = .006). The pretreatment SRC components did not independently affect the rate of pCR (1%-10% SRC: 4% [2/46] pCR; 11%-49% SRC: 25% [7/28] pCR; 50%-100% SRC: 7% [2/30] pCR). Kaplan-Meier analysis demonstrated worse survival among patients with any degree of SRC present on pretreatment biopsy, as compared with usual-type esophageal adenocarcinoma (P < .0001). Cox multivariable analysis failed to identify a relationship between increasing SRC component and poorer survival.
We present the only known evaluation of the percentage of SRC component in esophageal carcinoma. Our data support the hypothesis that esophageal adenocarcinoma with any component of SRC are more resistant to chemoradiation with poorer survival. Pathologic reporting of esophageal adenocarcinoma should include any component of SRC. Alternative therapies in patients with any SRC component may be indicated.
多项研究表明，具有印戒细胞（SRC）组织学特征的食管癌患者预后较差。传统上，SRC腺癌的定义是肿瘤中SRC成分≥50%。我们推测，SRC成分即使<50%的患者也会对标准多模式治疗产生耐药性，长期预后较差。
对2006年至2018年接受三联疗法治疗的腺癌患者的预处理活检标本进行SRC评估。食管病理学家对含有SRC肿瘤的苏木精和伊红染色切片进行重新评估，以量化SRC的百分比组成。
819例患者中有106例（13%）在至少1份病理标本中发现SRC组织学特征。普通型和SRC肿瘤的病理完全缓解（pCR）率分别为25%（177/713）和10%（11/106）（P = 0.006）。预处理时的SRC成分并未独立影响pCR率（1%-10% SRC：4% [2/46] pCR；11%-49% SRC：25% [7/28] pCR；50%-100% SRC：7% [2/30] pCR）。Kaplan-Meier分析显示，与普通型食管腺癌相比，预处理活检时有任何程度SRC的患者生存率较差（P < 0.0001）。Cox多变量分析未能确定SRC成分增加与生存率降低之间的关系。
我们提供了已知的唯一一项关于食管癌中SRC成分百分比的评估。我们的数据支持这样的假设，即含有任何SRC成分的食管腺癌对放化疗更具耐药性，生存率较差。食管腺癌的病理报告应包括任何SRC成分。对于有任何SRC成分的患者，可能需要采用替代疗法。
