title: The impact of preoperative radiochemotherapy on survival in advanced esophagogastric junction signet ring cell adenocarcinoma.
abstract: BACKGROUND
  Signet ring cell (SRC) tumors have a worse prognosis when compared with non-SRC tumors, and neoadjuvant chemotherapy has been suggested to be an ineffective treatment strategy. Preoperative radiochemotherapy, of already proven efficacy for esophagogastric junction adenocarcinomas (EGJA), could be an alternative neoadjuvant strategy for SRC EGJA. The aim of this retrospective study was to evaluate the survival impact of preoperative radiochemotherapy on patients with advanced resectable SRC EGJA.
  
  
  METHODS
  Of 3,010 patients registered in 21 French centers between January 1997 and January 2010, 2,670 underwent surgical resection, of whom 97 patients had a stage III SRC EGJA treated by either neoadjuvant radiochemotherapy followed by surgery (group RCT, n = 23) or primary surgery (group S, n = 74).
  
  
  RESULTS
  Groups were comparable by age, sex, American Society of Anesthesiologists score, malnutrition, and cTNM stage. There was evidence of significant tumoral (p = 0.003), nodal (p < 0.001), and pTNM (p < 0.001) downstaging after radiochemotherapy. In group RCT and group S, 3-year overall survival was 51% and 21% (p = 0.002), respectively, with disease recurrence rate of 30.4% versus 59.5% (p = 0.015), respectively. In multivariate analysis the sole independent favorable prognostic factor identified was the administration of neoadjuvant radiochemotherapy (hazard ratio 0.41, p = 0.020).
  
  
  CONCLUSIONS
  In the setting of locally advanced SRC EGJA, neoadjuvant radiochemotherapy is responsible for tumoral downstaging, reduced disease recurrence, and improved patient survival. A strategy of preoperative radiochemotherapy should be implemented in clinical practice to treat advanced SRC EGJA.
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bekkar
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France; North of France University, Lille, France; Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation, and Carcinogenesis," Jean Pierre Aubert Research Center, Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gronnier
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France; North of France University, Lille, France; Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation, and Carcinogenesis," Jean Pierre Aubert Research Center, Lille, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Messager
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France; North of France University, Lille, France.
authors.forename: William B
authors.initials: WB
authors.lastname: Robb
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France; North of France University, Lille, France; Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation, and Carcinogenesis," Jean Pierre Aubert Research Center, Lille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Piessen
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille, France; North of France University, Lille, France; Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation, and Carcinogenesis," Jean Pierre Aubert Research Center, Lille, France. Electronic address: christophe.mariette@chru-lille.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: 7