Postoperative Radiotherapy Improves Survival in Gastric Signet-Ring Cell Carcinoma: a SEER Database Analysis

Abstract

PurposeTo identify the potential therapeutic role of postoperative radiotherapy (RT) in patients with locally advanced (stage II and stage III) gastric signet ring cell carcinoma (SRC).Materials and methodsPatients with locally advanced gastric SRC from the Surveillance, Epidemiology, and End Results program database between 2004 and 2012 were included in our study. Univariate and multivariate Cox proportional models were performed, and survival curves were generated to evaluate the prognostic effect of postoperative RT and surgery alone on SRC patients. Propensity score matching (PSM) was used to avoid selection bias among the study cohorts.ResultsWe found that patients with postoperative RT had better probability of survival compared with those who did not receive RT (overall survival [OS], P<0.001; cancer-specific survival [CSS], P<0.001). After PSM, analysis of both overall and CSS showed that patients who underwent postoperative RT had better prognosis than those receiving surgery alone in the matched cohort (OS, P=0.00079; CSS, P=0.0036). Multivariate Cox proportional model indicated that postoperative RT had better effect on prognosis compared with surgery alone with respect to both overall (hazard ratio [HR], 0.716; 95% confidence interval [95% CI], 0.590–0.87; P=0.001) and CSS (HR, 0.713; 95% CI, 0.570–0.890; P=0.003).ConclusionsPostoperative RT had better prognosis compared with surgery alone for both overall and CSS for patients with locally advanced gastric SRC.

Improving survival of stage II‐III primary gastric signet ring cell carcinoma by adjuvant chemoradiotherapy

“…27 Wei's study reported that postoperative radiotherapy can provide a better survival in locally advanced GSRC patients (HR = 0.788, 95% CI: 0.64, 0.94). 26 This result provides the evidence for application of adjuvant RT on treatment of GSRC patients. In our study, we offer an alternative and effective treatment of adjuvant CRT for GSRC patients by analyzing the recent nationwide survey data.…”

“…25 As the same, Wei et al reported that postoperative chemotherapy did not improve survival (HR = 0.935, 95% CI: 0.674, 1.296) in 859 stage II-III GSRC patients. 26 Another study from Shi et al showed that survival benefits (HR = 0.28, 95% CI: 0.24, 0.32) of postoperative chemotherapy in 2815 stage IV GSRC patients. 27 Wei's study reported that postoperative radiotherapy can provide a better survival in locally advanced GSRC patients (HR = 0.788, 95% CI: 0.64, 0.94).…”

<p>Gastric Signet Ring Cell Carcinoma: Current Management and Future Challenges</p>

“…6 Similarly, a study by Wei et al demonstrated that postoperative chemotherapy did not provide a dramatic survival benefit in 1303 GSRC patients (HR=0.935, 95% CI: 0.674, 1.296). 44 Additionally, postoperative chemotherapy did not show a positive impact on survival in the 144 GSRC patients from Li's study (HR=0.654, 95% CI: 0.271, 1.581). 45 It appears that only Shi et al suggested that a selected group of stage IV GSRC patients benefited from postoperative chemotherapy (HR = 0.61, 95% CI: 0.51-0.73).…”

“…46 Nonetheless, from the perspective of Wei, postoperative radiotherapy provided more possibilities for survival (HR=0.788, 95% CI: 0.644, 0.009) of patients with locally advanced GSRC. 44 Most previous studies did not offer compelling evidence on this issue. Therefore, more randomized controlled trials are required in further studies.…”

Superior survival in right-sided versus left-sided colon signet ring cell carcinoma

“…Besides, tumor sidedness was divided into left-sided colon (including splenic flexure, descending colon, sigmoid colon and rectosigmoid cancers) and right-sided colon (including cecum, ascending colon, hepatic flexure and transverse colon) 12 , 15 , 22 , 23 . Age and tumor size were grouped in accordance with prior researches 24 , 25 . In addition, the staging of cancer is based on the 6th edition of AJCC stage system, which adapted to patients in the SEER database with from 2004 to 2015.…”