Colorectal signet-ring cell carcinoma: benefit from adjuvant chemotherapy but a poor prognostic factor

Abstract

Colorectal signet-ring cell carcinoma (SRCC) has been associated with poor survival compared with mucinous adenocarcinoma (MC) and the more common adenocarcinoma (AC). Efficacy of adjuvant chemotherapy in SRCC has never been assessed. This study analyzes the prognostic impact of SRCC and determines whether colonic SRCC patients benefit from adjuvant chemotherapy equally compared with MC and AC patients. Data on 196,757 colorectal cancer (CRC) patients in the period 1989-2010 was included in this Dutch nationwide population-based study. Five-year relative survival estimates were calculated and multivariate relative survival analyses using a multiple regression model of relative excess risk (RER) were performed. SRCC was found in 1,972 (1.0%) patients. SRCC patients presented more frequently with stage III or IV disease than AC patients (75.2% vs. 43.6%, p < 0.0001) and SRCC was more frequently found in the proximal colon (57.7 vs. 32.0%, p < 0.0001). SRCC patients had a poor 5-year relative survival of 30.8% (95% CI 28.1-33.6%) in the colon and 19.5% (95% CI 14.7-24.8%) in the rectum compared with 56.8% (95% CI 56.4-57.1%) and 58.5% (95% CI 57.9-59.1%) for AC. This survival difference was found in stage II, but was most prominent in stage III. Compared with AC, there was no significant interaction between SRCC and adjuvant chemotherapy (RER 1.10, 95% CI 0.81-1.51), suggesting a comparable benefit from adjuvant chemotherapy in AC and SRCC. In conclusion, the prognostic impact of SRCC is dismal in both colon and rectal cancer patients, but adjuvant chemotherapy is associated with improved survival in AC, MC, and SRCC patients.

A Case of Signet Ring Cell Carcinoma of the Gallbladder Which Was Treated by Aggressive Surgery and Intensive Adjuvant Chemotherapy

“…Gallbladder cancer is recognized to be a malignant tumor with a poor prognosis [1]. In gastric and colorectal cancer, SRCC generally has a worse prognosis than adenocarcinoma, which is the most common histological type [7,8]. Considering these findings, it is assumed that SRCC of the gallbladder is associated with a poor prognosis.…”

Primary signet ring cell carcinoma of the colon and rectum

“…The reported frequency varies from 0.3 to 4.6% of all colorectal carcinomas with slight differences between western countries, Asia and Africa (figure 1) [3,[5][6][7][8][9][10][11][12]. The highest incidence of SRCC of the colon and rectum is reported in countries with low overall prevalence of colorectal cancer, such as Tanzania [10].…”

“…This large difference in age among series is likely due to the bias associated with single institution studies including small number of patients. However, all studies have shown that SRCC of the large bowel significantly occurs in younger individuals as compared to other colorectal carcinomas [9,11,13]. Incidence rates for colonic and rectal SRCC differ by race/ethnicity.…”

“…However, these data should be interpreted carefully because the majority of epidemiological data on SRCC of the colon and rectum are based on single institution studies [5,6,10], rarely from large population-based studies of colorectal cancer histology [11,12]. The mean age at diagnosis of colorectal SRCC reported in published series ranges from 48 to 70 years old [7,9]. This large difference in age among series is likely due to the bias associated with single institution studies including small number of patients.…”

The utility of sensor technology to support reproductive management on dairy farms

“…Prognostic models are frequently used in clinical epidemiology, mainly in human medicine. For example, the prognosis of therapy success for colon cancer (Hugen, et al, 2015). The purpose of prognostic modeling is to generate a prognosis (or expectation) of further or future development of a disease.…”