Impact of Signet-Ring Cell Histology in the Management of Patients with Non-Metastatic Gastric Cancer: Results from a Retrospective Multicenter Analysis Comparing FLOT Perioperative Chemotherapy vs. Surgery Followed by Adjuvant Chemotherapy.

Autor: Giampieri R; Medical Oncology Unit, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti delle Marche, 60126 Ancona, Italy., Baleani MG; Department of Oncology, Ospedale Generale Provinciale, 62100 Macerata, Italy., Bittoni A; Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', 47014 Meldola, Italy., Rastelli F; Department of Oncology, Ospedale 'C.e G. Mazzoni' Ascoli Piceno, 63100 Ascoli Piceno, Italy., Catalano V; Department of Oncology, Ospedale Santa Maria della Misericordia, AV1, 61029 Urbino, Italy., Del Prete M; Department of Oncology, Ospedale Augusto Murri di Fermo, 63900 Fermo, Italy., Chiorrini S; Department of Oncology, Ospedale E. Profili, 60044 Fabriano, Italy., Pinterpe G; Medical Oncology Unit, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti delle Marche, 60126 Ancona, Italy., Graziano F; Department of Oncology, Azienda Ospedaliera Marche Nord, AV1, 61121 Pesaro, Italy., Giorgi FC; Department of Oncology, Ospedale Madonna del Soccorso, 63074 San Benedetto del Tronto, Italy., Bisonni R; Department of Oncology, Ospedale Augusto Murri di Fermo, 63900 Fermo, Italy., Silva R; Department of Oncology, Ospedale E. Profili, 60044 Fabriano, Italy., Alessandroni P; Department of Oncology, Azienda Ospedaliera Marche Nord, AV1, 61121 Pesaro, Italy., Mencarini L; Medical Oncology Unit, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti delle Marche, 60126 Ancona, Italy., Berardi R; Medical Oncology Unit, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti delle Marche, 60126 Ancona, Italy.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2023 Jun 25; Vol. 15 (13). Date of Electronic Publication: 2023 Jun 25.
DOI: 10.3390/cancers15133342
Abstrakt: Background: FLOT perioperative chemotherapy represents the standard of care in non-metastatic gastric cancer patients. Signet-ring cell positivity is associated with a worse prognosis in patients with gastric cancer treated with chemotherapy. Comparison between FLOT perioperative chemotherapy vs. surgery followed by adjuvant chemotherapy based on signet-ring cell positivity is lacking. The aim of the analysis was to compare perioperative FLOT with adjuvant chemotherapy in gastric cancer patients stratified by signet-ring cell positivity.
Methods: We conducted a retrospective multicenter analysis based on disease-free survival (DFS) and overall survival (OS) in patients with gastric cancer who received perioperative chemotherapy with a FLOT regimen and compared their survival with a historical cohort of patients treated with adjuvant chemotherapy, matched by cT and cN stage and by tumor histological features.
Results: Seventy-six patients were enrolled and 24 (32%) were signet-ring cell positive. At a median follow-up time of 39 months, the median DFS was 26.3 months and the median OS was 37.3 months. Signet-ring cell positivity was associated with a shorter OS (median OS: 20.4 vs. 46.9 months, HR: 3.30, 95%CI: 1.56-6.99, p = 0.0018) and DFS (mDFS: 15.2 vs. 38.6 months, HR: 3.18, 95%CI: 1.55-6.54, p = 0.0016). This was confirmed by multivariate analysis for DFS (Exp(B): 2.55) and OS (Exp(B): 2.68). After propensity score matching, statistically significant shorter DFS (HR: 3.30, 95%CI: 1.50-7.35, p = 0.003) and OS (HR: 5.25, 95%CI: 2.18-12-68, p = 0.0002) were observed for patients with signet-ring cell positivity who received perioperative treatment vs. those who received surgery followed by adjuvant chemotherapy.
Conclusions: Signet-ring positivity was associated with shorter DFS and OS in patients who received perioperative treatment with FLOT compared with surgery followed by adjuvant therapy. These data suggest that for patients with signet-ring cell histology, FLOT perioperative treatment might not always be the best choice of treatment, and further research should be focused on this group of patients.
Databáze: MEDLINE
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