The Impact of Preoperative Radiochemotherapy on Survival in Advanced Esophagogastric Junction Signet Ring Cell Adenocarcinoma

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 p 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.