Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Departmentof Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Surg Oncol. 2024 Sep;130(3):428-434. doi: 10.1002/jso.27774. Epub 2024 Jul 14.
Although signet ring cell (SRC) histology is associated with resistance to neoadjuvant chemoradiotherapy and worse overall survival (OS) in esophageal adenocarcinoma (EAC), its prognostic relationship among patients who survive the early period following resection is unknown. EAC patients who underwent trimodality therapy at a single institution (2006-2018) were identified. Bayesian multivariable regression (BMR) analyses of OS and additional OS from a 3-year landmark were performed.
Of 631 patients, SRCs were present in 16.0% (N = 101). SRC was associated with shorter median OS (45.8 [95% confidence interval: 31.0-96.7] vs. 79.8 [63.0-107.2] months; p = 0.014). In BMR analysis, the absence of an SRC component was moderately associated with improved OS (probability of beneficial effect, PBE = 0.879). Three-year conditional BMR analysis of additional OS (N = 357) showed that SRC status no longer had a prognostic effect (PBE = 0.546); higher pathological stage was strongly associated with worse additional OS (PBE < 0.001).
The presence of SRC portends worse OS following trimodality therapy for EAC. However, this prognostic impact is dynamic and abates by 3 years postoperatively. In contrast, a higher pathological stage is strongly associated with poor overall and 3-year conditional survival.
These findings may inform postoperative patient counseling and surveillance protocols.
虽然印戒细胞（SRC）组织学与食管腺癌（EAC）对新辅助放化疗的耐药性和总体生存率（OS）降低相关，但在接受切除术后早期存活的患者中，其预后关系尚不清楚。在一个机构（2006-2018 年）接受三联疗法的 EAC 患者被确定。对 OS 进行贝叶斯多变量回归（BMR）分析，并在 3 年时间点进行了额外的 OS 分析。
在 631 名患者中，SRC 占 16.0%（N=101）。SRC 与较短的中位 OS 相关（45.8 [95%置信区间：31.0-96.7] vs. 79.8 [63.0-107.2]个月；p=0.014）。在 BMR 分析中，缺乏 SRC 成分与 OS 改善中度相关（有益效果的概率，PBE=0.879）。对额外 OS 的 3 年条件 BMR 分析（N=357）表明，SRC 状态不再具有预后作用（PBE=0.546）；较高的病理分期与较差的额外 OS 强烈相关（PBE<0.001）。
在接受 EAC 的三联疗法后，SRC 的存在预示着 OS 较差。然而，这种预后影响是动态的，术后 3 年减弱。相比之下，较高的病理分期与较差的整体和 3 年条件生存率强烈相关。
这些发现可能为术后患者咨询和监测方案提供信息。
