Outcomes Of Neoadjuvant Chemoradiation Versus Neoadjuvant Chemotherapy For Esophageal Junction Signet Ring Cell Adenocarcinoma.
Publication/Presentation Date
6-5-2026
Abstract
BACKGROUND: Gastroesophageal junction (GEJ) adenocarcinoma with signet ring cells (SRC) is associated with resistance to therapy and poor outcomes. Standard neoadjuvant regimens for SRC have been chemoradiation (nCRT) or chemotherapy (nCT), with little data specific to SRC indicating which is optimal. We compared outcomes of resectable (stage I-III) GEJ SRC patients treated with nCRT or nCT followed by surgery.
METHODS: Patients undergoing esophagectomy for GEJ SRC after neoadjuvant therapy at two different institutions (2005-2022) were stratified by receipt of nCRT or nCT. Propensity scores, based on demographic and clinical characteristics, were used to match groups (2 nCRT:1 nCT). Outcomes were assessed using Kaplan-Meier and multivariable Cox regression models.
RESULTS: In sum, 104 (66.7%) nCRT and 52 (33.3%) nCT patients were included. Most patients were male (nCRT, n=88/104, 84.6%; nCT, n=43/52, 82.7%, p=0.76) with clinical stage III (nCRT, n=92/104, 88.5%; nCT, n=48/52, 92.3%, p=0.33). Patients treated with nCRT achieved pathological complete response (pCR) 11.5% versus 7.7% for nCT patients. At median follow-up of 27 months, median survival for nCRT patients was 34.3 months (95%CI: 24.9-72.1) compared to 34.5 months (95%CI: 29.0-58.8, P=0.28) for nCT patients. Multivariate Cox regression indicated that lymphovascular invasion was an independent predictor of progression-free and overall survival, but choice of neoadjuvant therapy was not.
CONCLUSIONS: The treatment-resistant nature of signet ring cells pose consequential challenges that are not overcome by nCRT nor nCT. Novel therapeutic strategies are needed to improve outcomes for patients with GEJ adenocarcinoma with SRC.
ISSN
1552-6259
Published In/Presented At
Hooda, Z., Langburt, D., McCracken, A., Carbone, G., Ries, S., Antonoff, M. B., Correa, A. M., Mehran, R., Rajaram, R., Rice, D., Swisher, S., Vaporciyan, A., Walsh, G., Mitchell, K. G., Ferri, L., & Hofstetter, W. (2026). Outcomes Of Neoadjuvant Chemoradiation Versus Neoadjuvant Chemotherapy For Esophageal Junction Signet Ring Cell Adenocarcinoma. The Annals of thoracic surgery, S0003-4975(26)00532-1. Advance online publication. https://doi.org/10.1016/j.athoracsur.2026.05.033
Disciplines
Medicine and Health Sciences
PubMedID
42250584
Department(s)
Fellows and Residents
Document Type
Article