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