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Signet Ring Cell Features are Associated with Poor Response to Neoadjuvant Treatment and Dismal Survival in Patients with High-Grade Esophageal Adenocarcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

While the prognosis of patients with locoregional esophageal adenocarcinoma (EAC) has improved in the neoadjuvant treatment (NAT) era, high-grade histology (G3) is still associated with a limited treatment response. We sought to investigate oncologic outcomes in patients after esophagectomy for G3 EAC and to identify predictors of poor survival among these patients.

Methods

Patients with EAC who underwent resection with curative intent in 2011–2018 were divided by histologic grade (G3, G1/2) and compared for overall survival (OS). Cox regression was performed to analyze the response to NAT and the predictive role of signet ring cell (SRC) features.

Results

The cohort included 163 patients, 94 (57.7%) with G3 histology. NAT was administered to 69 (73.4%) patients. Following resection, OS in the G3 EAC group was 30 months (95% confidence interval [CI] 23.9–36.1). On univariate analysis, G3 disease (p = 0.050) and SRC features (p = 0.019) predicted low OS. Median survival in the G3 EAC group was worse in patients with SRC histology (18 months, 95% CI 8.6–27.4) than those without (30 months, 95% CI 23.8–36.1; p = 0.041). No patients with SRC histology were alive at 5 years of follow-up. Among all patients administered NAT, 88.2% of those with SRC showed minimal or no pathologic response and only 27.8% were downstaged.

Conclusions

High-grade histology was found in most patients with EAC and predicted poor survival and treatment response. SRC features in patients with G3 disease were associated with lower OS. The benefit of NAT for G3 EAC in patients with SRC histology appears limited.

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Authors and Affiliations

  1. Department of Surgery, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel

    Daniel Solomon MD, Muhammad Abbas MD, Yael Feferman MD, Nikolai Menasherov MD & Hanoch Kashtan MD

  2. Department of Surgery, Carmel Carmel Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Riad Haddad MD

  3. Davidoff Cancer Center, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel

    Gali Perl MD & Yulia Kundel MD

  4. Department of Pathology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel

    Sara Morgenstern MD

  5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Daniel Solomon MD, Muhammad Abbas MD, Yael Feferman MD, Gali Perl MD, Yulia Kundel MD, Sara Morgenstern MD, Nikolai Menasherov MD & Hanoch Kashtan MD

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Correspondence to Hanoch Kashtan MD.

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Daniel Solomon, Muhammad Abbas, Yael Feferman, Riad Haddad, Gali Perl, Yulia Kundel, Sara Morgenstern, Nikolai Menasherov, and Hanoch Kashtan have no disclosures to declare.

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Solomon, D., Abbas, M., Feferman, Y. et al. Signet Ring Cell Features are Associated with Poor Response to Neoadjuvant Treatment and Dismal Survival in Patients with High-Grade Esophageal Adenocarcinoma. Ann Surg Oncol 28, 4929–4940 (2021). https://doi.org/10.1245/s10434-021-09644-1

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