Most Read Articles
22 May 2017
Chronic obstructive pulmonary disease (COPD) is currently the 10th commonest cause of death in Singapore, with a disease burden of 5.9 percent according to a 2015 population-based survey (EPIC-Asia survey) in Singapore. Pearl Toh spoke with Dr Augustine Tee, chief and senior consultant of the Department of Respiratory and Critical Care Medicine at Changi General Hospital (CGH) in Singapore, on how COPD is often underdetected in the primary care population as symptoms are not specific and diagnosis requires a combination of clinical risk factors, symptoms and spirometry testing.
15 Aug 2017
New drug applications approved by US FDA as of 1 - 15 August 2017 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.
04 Aug 2017
Chronic obstructive pulmonary disease (COPD) is the fourth cause of global mortality, with experts predicting a potential future rise in the prevalence rates of COPD. 
11 May 2016

In conjunction with World Asthma Day which falls on 3rd May 2016, MIMS Doctor speaks to a renowned respiratory medicine specialist, Dato' Dr. Hj Abdul Razak Abdul Muttalif, regarding the chronic airway disease.

Tumour grade, metastasis up mortality in signet ring cell carcinoma of the oesophagus

Tristan Manalac
28 Jul 2017

Distant metastasis, regional lymph node metastasis, no chemotherapy and invasion of adjacent organs are all independent predictors of high disease-specific mortality (DSM) in signet ring cell carcinoma of the oesophagus (SRCCE), a new study has found.

“SRCCE is an extremely rare oncologic abnormality that may originate from cancer stem cells, with the propensity to metastasize to distant sites at an early stage; to date, limited research on SRCCE survival has been reported,” said researchers.

“Social-demographic and clinical predictors, including being unmarried, having a tumor size  5 cm, a high tumor grade, tumor invasion of adjacent organs, regional lymph node metastasis, distant metastasis and no chemotherapy, are independent prognosticators for high DSM,” they added.

Over the 11-year study period, the median survival for 537 SRCCE patients (mean age 67.2±12.3 years; 85.84 percent male) was 12.0 months. The 1-year DSM was 51.6 percent while the 2- and 5-year DSMs were 67.6 and 78.4 percent, respectively. [PLoS One 2017;doi:10.1371/journal.pone.0181845]

Multivariate Cox proportional hazards analyses showed that unmarried patients (hazard ratio [HR], 1.443; 95 percent CI, 1.102 to 1.890; p=0.008) had significantly higher risks of mortality than those who were married.

“The importance of marital status has already been reported. It is considered to be an independent predictor for prognosis in various malignancies, and those who are married exhibit better survival in colorectal cancer, prostate cancer and mammary gland cancer,” researchers explained.

“Marital status can impact coping strategies, quality of life and emotion as a significant component of social support,” they added.

Similarly, a tumour size ≥5.0 cm (HR, 1.444; 1.096 to 1.904; p=0.009), high tumour grade (HR, 3.001; 1.107 to 8.130; p=0.031), T4 primary tumour stage (HR, 2.178; 1.453 to 3.265; p<0.001), N1 regional lymph node metastasis (HR, 1.739; 1.296 to 2.333; p<0.001) and M1 distant metastasis (HR, 1.951; 1.455 to 2.614; p<0.001) were all significantly associated with higher mortality.

In contrast, chemotherapy showed a significant protective factor against mortality (HR, 0.464; 0.327 to 0.659; p<0.001) compared with those who did not receive chemotherapy. The 5-year DSM for patients who underwent chemotherapy was lower than those who did not (76.9 vs 80.4 percent).

“[M]ore advanced SRCCE adversely affected the survival time. Patients with intrusion of the neoplasm into neighboring organs, regional lymph node metastasis and distant transfer showed much shorter survival times, with consistent conclusions found in early studies,” said researchers.

Because the study drew heavily from data in The Surveillance, Epidemiology, and End Results (SEER) programme database, important limitations exist. For instance, several important variables, such as surgical margins, comorbidities, recurrence and extent of the surgery, were unavailable.

The anonymous nature of the database also prevented the researchers from personally contacting the individual patients to collect more information.

“Considering the lack of information for surgical margins, extent of resection, comorbidities and neoplasm recurrence, which affect the patients' prognosis, further investigations combined with multiple fields are expected to elucidate favourable treatment strategies for SRCCE,” they said.

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Most Read Articles
22 May 2017
Chronic obstructive pulmonary disease (COPD) is currently the 10th commonest cause of death in Singapore, with a disease burden of 5.9 percent according to a 2015 population-based survey (EPIC-Asia survey) in Singapore. Pearl Toh spoke with Dr Augustine Tee, chief and senior consultant of the Department of Respiratory and Critical Care Medicine at Changi General Hospital (CGH) in Singapore, on how COPD is often underdetected in the primary care population as symptoms are not specific and diagnosis requires a combination of clinical risk factors, symptoms and spirometry testing.
15 Aug 2017
New drug applications approved by US FDA as of 1 - 15 August 2017 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.
04 Aug 2017
Chronic obstructive pulmonary disease (COPD) is the fourth cause of global mortality, with experts predicting a potential future rise in the prevalence rates of COPD. 
11 May 2016

In conjunction with World Asthma Day which falls on 3rd May 2016, MIMS Doctor speaks to a renowned respiratory medicine specialist, Dato' Dr. Hj Abdul Razak Abdul Muttalif, regarding the chronic airway disease.