J Gastric Cancer.  2019 Dec;19(4):393-407. 10.5230/jgc.2019.19.e36.

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

Affiliations
  • 1Department of Gastroenterology, The Fifth People's Hospital of Shanghai Fudan University, Shanghai, China. cfy429@163.com
  • 2Central Laboratory, The Fifth People's Hospital of Shanghai Fudan University, Shanghai, China.

Abstract

PURPOSE
To 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 METHODS
Patients 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.
RESULTS
We 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).
CONCLUSIONS
Postoperative RT had better prognosis compared with surgery alone for both overall and CSS for patients with locally advanced gastric SRC.

Keyword

Signet ring cell carcinoma; Radiotherapy; Gastric cancer; Nomogram; Propensity score

MeSH Terms

Carcinoma, Signet Ring Cell
Cohort Studies
Humans
Nomograms
Prognosis
Propensity Score
Radiotherapy*
SEER Program
Selection Bias
Stomach Neoplasms

Figure

  • Fig. 1 Flowchart of study design. SRC = signet ring cell carcinoma; RT = radiotherapy; NLNE = number of lymph nodes examined.

  • Fig. 2 (A, B) Both overall and CSS analysis showed that patients with locally advanced (stage II/III) cancer that underwent postoperative radiotherapy had better prognosis than those receiving surgery alone after propensity score matching (OS, P=0.00079; CSS, P=0.0036). OS = overall survival; CSS = cancer-specific survival.

  • Fig. 3 (A, B) Both overall and CSS analysis showed that stage II patients that underwent postoperative RT had better prognosis than those receiving surgery alone after PSM (OS, P=0.037; CSS, P=0.036); (C, D) Both overall and CSS analysis showed that stage III patients that underwent postoperative RT had better prognosis than those receiving surgery alone after PSM (OS, P=0.0039; CSS, P=0.022). OS = overall survival; CSS = cancer-specific survival; RT = radiotherapy; PSM = propensity score matching.

  • Fig. 4 Prognostic nomogram for CSS in patients with locally advanced signet ring cell carcinoma in the stomach. To use this nomogram, first locate the patient's age, then draw a line straight up to the points axis on the top to get the score associated with age. Repeat the process for the other covariates (from Race to Radiation). Total points were calculated by summing the projection points on the scale of each variable to determine the CSS probability of 3-, 5-, and 10- years. CSS = cancer-specific survival; NLNE = number of lymph nodes examined.


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