Dataset Information

The Predictive and Guidance Value of Signet Ring Cell Histology for Stage II/III Colon Cancer Response to Chemotherapy.

ABSTRACT:

Purpose

To evaluate the predictive and guidance value of signet-ring cell carcinoma for chemotherapy response in stage II/III colon cancer.

Methods

Eligible patients were recruited from the Surveillance, Epidemiology and End Results (SEER) database. The differences between adenocarcinoma (AD) and SRCC groups in the incidence of patients' demographic and clinical characteristics were analyzed by Pearson's chi-squared (×2) test. Survival was analyzed using the Kaplan-Meier method, and the differences were determined by the log-rank test. Some Cox regression models were built to assess hazard ratios (HRs) of different variables with 95% confidence intervals (95% CIs).

Results

In stage II AD, it was found that the receipt of chemotherapy had significantly 12.6% decreased risk of cancer-specific mortality (HR = 0.874, 95% CI = 0.825-0.927, P < 0.001). In stage II SRCC, however, the receipt of chemotherapy had significantly 70.00% increased risk of cancer-specific mortality (HR = 1.700, 95% CI = 1.032-2.801, P = 0.037). In stage III AD, it was found that the receipt of chemotherapy had significantly 45.3% decreased risk of cancer-specific mortality (HR = 0.547, 95% CI = 0.530-0.564, P < 0.001). In stage III SRCC, the receipt of chemotherapy had significantly 24.6% decreased risk of cancer-specific mortality (HR = 0.754, 95% CI = 0.632-0.900, P = 0.002).

Conclusions

The cancer-specific survival (CSS) difference between AD and SRCC was not statistically significant in stage II colon cancer. We provided the first compelling evidence that chemotherapy should not be treated in stage II SRCC, while stage III SRCC should be treated with chemotherapy.

SUBMITTER: Jiang H

PROVIDER: S-EPMC7940524 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

The Predictive and Guidance Value of Signet Ring Cell Histology for Stage II/III Colon Cancer Response to Chemotherapy.

Jiang Huici H Shao Dongxuan D Zhao Peiyu P Wu Yupeng Y

Frontiers in oncology 20210223

<h4>Purpose</h4>To evaluate the predictive and guidance value of signet-ring cell carcinoma for chemotherapy response in stage II/III colon cancer.<h4>Methods</h4>Eligible patients were recruited from the Surveillance, Epidemiology and End Results (SEER) database. The differences between adenocarcinoma (AD) and SRCC groups in the incidence of patients' demographic and clinical characteristics were analyzed by Pearson's chi-squared (×2) test. Survival was analyzed using the Kaplan-Meier method, a ...[more]

PMID: 33708632

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Project description:BackgroundSurgery alone is standard-of-care for stage I gastric adenocarcinoma; however, clinicians can offer preoperative therapy for clinical stage I disease with signet ring cell histology, given its presumed aggressive biology. We aimed to assess the validity of this practice.MethodsThe National Cancer Database (2004-2015) was reviewed for patients with clinical stage I signet ring cell gastric adenocarcinoma who underwent treatment with surgery alone, perioperative chemotherapy, neoadjuvant therapy, or adjuvant therapy. Analysis was stratified by preoperative clinical/pathologic stage. Primary outcome was overall survival (OS).ResultsOf 1018 patients, median age was 60 years (±14); 53% received surgery alone (n = 542), 5% received perioperative chemotherapy (n = 47), 12% received neoadjuvant therapy (n = 125), and 30% received adjuvant therapy (n = 304). For clinical stage I disease, surgery alone was associated with an improved 5-year OS rate (71%) versus perioperative chemotherapy (58%), neoadjuvant therapy (38%), or adjuvant therapy (52%) [overall p < 0.01]. For pathologic stage I, surgery alone had equivalent or improved survival compared with perioperative, neoadjuvant, and adjuvant therapy (5-year OS: 78% vs. 89% [p = 0.77] vs. 64% [p = 0.04] vs. 84% [p = 0.99]). Adjuvant therapy was associated with improved 5-year OS compared with pretreatment for those patients upstaged (37%) to pathologic stage II/III (55% vs. 36% and 34% vs. 7%; all p < 0.01).ConclusionsThis stage-specific study demonstrates improved survival with surgery alone for clinical stage I signet ring cell gastric adenocarcinoma. Despite 37% of clinical stage I patients being upstaged to pathologic stage II/III, adjuvant therapy offers a favorable rescue strategy, with improved outcomes compared with those treated preoperatively. Surgery alone also affords similar or improved survival for pathologic stage I disease versus multimodality therapy. This study challenges the bias to overtreat stage I signet ring cell gastric adenocarcinoma.

Project description:BackgroundSince 2004, a regimen of 6 months of treatment with oxaliplatin plus a fluoropyrimidine has been standard adjuvant therapy in patients with stage III colon cancer. However, since oxaliplatin is associated with cumulative neurotoxicity, a shorter duration of therapy could spare toxic effects and health expenditures.MethodsWe performed a prospective, preplanned, pooled analysis of six randomized, phase 3 trials that were conducted concurrently to evaluate the noninferiority of adjuvant therapy with either FOLFOX (fluorouracil, leucovorin, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin) administered for 3 months, as compared with 6 months. The primary end point was the rate of disease-free survival at 3 years. Noninferiority of 3 months versus 6 months of therapy could be claimed if the upper limit of the two-sided 95% confidence interval of the hazard ratio did not exceed 1.12.ResultsAfter 3263 events of disease recurrence or death had been reported in 12,834 patients, the noninferiority of 3 months of treatment versus 6 months was not confirmed in the overall study population (hazard ratio, 1.07; 95% confidence interval [CI], 1.00 to 1.15). Noninferiority of the shorter regimen was seen for CAPOX (hazard ratio, 0.95; 95% CI, 0.85 to 1.06) but not for FOLFOX (hazard ratio, 1.16; 95% CI, 1.06 to 1.26). In an exploratory analysis of the combined regimens, among the patients with T1, T2, or T3 and N1 cancers, 3 months of therapy was noninferior to 6 months, with a 3-year rate of disease-free survival of 83.1% and 83.3%, respectively (hazard ratio, 1.01; 95% CI, 0.90 to 1.12). Among patients with cancers that were classified as T4, N2, or both, the disease-free survival rate for a 6-month duration of therapy was superior to that for a 3-month duration (64.4% vs. 62.7%) for the combined treatments (hazard ratio, 1.12; 95% CI, 1.03 to 1.23; P=0.01 for superiority).ConclusionsAmong patients with stage III colon cancer receiving adjuvant therapy with FOLFOX or CAPOX, noninferiority of 3 months of therapy, as compared with 6 months, was not confirmed in the overall population. However, in patients treated with CAPOX, 3 months of therapy was as effective as 6 months, particularly in the lower-risk subgroup. (Funded by the National Cancer Institute and others.).

Dataset Information

The Predictive and Guidance Value of Signet Ring Cell Histology for Stage II/III Colon Cancer Response to Chemotherapy.

Purpose

Methods

Results

Conclusions

Publications

The Predictive and Guidance Value of Signet Ring Cell Histology for Stage II/III Colon Cancer Response to Chemotherapy.

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