Retrospective Analysis of Patients with Signet Ring Subtype of Colorectal Cancer with Peritoneal Metastasis Treated with CRS & HIPEC

Abstract

Signet ring cell subtype (SRC) of colorectal cancer (CRC) is a rare subtype and occurs in approximately 1% of all patients with CRC. Patients with peritoneal metastasis (PM) of SRC have a poor prognosis, and this subtype is frequently considered as a contra-indication for extensive surgical treatment. This retrospective study from two dedicated peritoneal surface malignancy centers in Japan included all patients treated with CRS ± hyperthermic intraperitoneal chemotherapy (HIPEC) between July 1994 and December 2017 from a prospectively maintained database. Preoperative, operative, and postoperative parameters were recorded, including complication rates and follow-up. Sixty of the 320 patients treated with CRS due to CRC were diagnosed with SRC subtype. The mean age of the patients was 51.4 years, and the mean peritoneal carcinomatosis index (PCI) was 13.1. Complete cytoreduction was achieved in 61.7% of cases. The postoperative morbidity rate was 25% and the mortality rate was 1.7%. The median overall survival (OS) was 14.4 months. Cox regression analysis revealed small bowel PCI > 2 (hazard ratio (HR) 6.5; p = 0.008) as the most important factor for OS. With accurate patient selection (e.g., PCI ≤ 12 or small bowel PCI ≤ 2), even patients with PM of CRC with SRC subtype may benefit from CRS and HIPEC, with median OS from 17.8 to 20.8 months and 5-year OS of 11.6%.

Clinicopathological and Molecular Characteristics of Colorectal Signet Ring Cell Carcinoma: A Review

“…As for CRC with PM, it has been reported that cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is beneficial for selected patients [ 85 ]. However, properly selecting candidates who may benefit from this treatment is very important.…”

Lymph Node Metastases from Visceral Peritoneal Colorectal Metastases are Associated with Systemic Recurrence

“…The combination of CRS and HIPEC has yielded a 30% to 50% 5-year survival rate for well-selected patients 3,4 compared with a 5-year survival rate lower than 10% under modern chemotherapy. 5 However, major morbidity is reported to be in the range of 30% to 45% of cases, even in specialized centers, [6][7][8] and about 30% of patients sustain early (\ 12 months) recurrence. [9][10][11] In an attempt to optimize surgical results, various prognostic factors have been proposed to aid in patient selection for this complicated procedure that includes completeness of cytoreduction, intraabdominal tumor burden as measured by the Peritoneal Carcinomatosis Index (PCI), tumor clinical presentation, and histologic characteristics.…”