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The Significance of Signet Ring Cell Histology in Early Esophageal Adenocarcinoma
Stephanie G. Worrell*, Steven R. Demeester, Joseph D. Dixon, Christina L. Greene, Daniel S. OH, Jeffrey a. Hagen
Keck School of Medicine of Univeristy of Southern California, Los Angeles, CA
Background: Signet ring cell (SRC) histology is thought to confer a worse prognosis for gastric and esophageal cancers and the appropriateness of endoscopic therapy for superficial adenocarcinoma of the esophagus with SRC histology is controversial. Our aim was to evaluate the impact of SRC histology on lymph node metastasis and survival in patients with early esophageal adenocarcinoma.
Methods: A retrospective chart review was performed of all patients with esophageal or gastroesophageal junction adenocarcinoma who underwent primary esophagectomy for a pT1-2 tumor that was ≤5cm in size from 4/1990 to 5/2012. Patient characteristics and survival were compared based on the presence or absence of SRC histology.
Results: There were 200 patients that met inclusion criteria, 16 (8%) had SRC histology and 184 were non-SRC. Esophagectomy consisted of en bloc transthoracic (n=98), transhiatal (n=64), or vagal-sparing (n=38). There was no difference in type of esophagectomy between groups. Patient demographics, tumor characteristics, and survival are compared in the Table. Patients with SRC were younger and more likely to have involved nodes. All 4 patients with pT1a SRC tumors were N0 compared to 97 of 99 patients (98%) with non-SRC histology. In patients with T1b or T2 lesions, those with SRC histology were more likely to have lymph node metastases [7/12 (58%) for SRC versus 26/85 (31%) for non-SRC, p=0.09]. In addition, T1b or T2 patients with SRC histology were more likely to have N2-3 disease (SRC 58% versus 15% for non-SRC, p=0.002). Overall 5 year and disease specific survival were equivalent between groups.
Conclusions: Intramucosal (T1a) adenocarcinoma with or without SRC histology has a low risk of lymph node metastases and endoscopic resection can be considered in these patients. However, deeper invasion with SRC histology was associated with a significantly increased risk of lymph node metastases compared to similar invasion without SRC histology. Further, patients with SRC histology were more likely to have multiple (N2-3) involved nodes. Neoadjuvant therapy prior to surgical resection is recommended for T1b or deeper lesions that show SRC histology.
| Total n=200 | SRC n=16 | No SRC n=184 | p value | | Sex M:F | 14:2 | 149:35 | 0.52 | | Age (years) | 59 | 67 | 0.047 | | T status pT1a pT1b pT2 | 4 (25%) 6 (37.5%) 6 (37.5%) | 99 (54%) 42 (23%) 43 (23%) | 0.09 | | N status pN0 pN1 pN2-3 | 9 (56%) 0 7 (44%) | 156 (85%) 15 (8%) 13 (7%) | <0.0001 | | Median tumor size (cm) | 1.5 | 1 | 0.25 | | 5 year overall survival | 73% | 69% | 0.65 | | 5 year disesase specific survival | 86% | 86% | 0.09 |
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