Abstract
As well known, signet-ring cell carcinoma (SRCC) is a rare histological subtype of colorectal adenocarcinoma, which has been associated with poor prognosis and resistant to non-surgery therapy compared with common adenocarcinoma. In this study, we assessed the effect of preoperative radiotherapy (PRT) for locally advanced rectal SRCC in a large patient group from the Surveillance, Epidemiology, and End Results program (SEER, 1988–2011) database. SRCC was found in 0.9% (n = 622) rectal cancer (RC) patients in our study. In the PRT setting, SRCC had significantly worse cancer-specific survival than mucinous adenocarcinoma and nonmucinous adenocarcinoma patients (log-rank, P < 0.001). In terms of SRCC, stage III RC patients benefited from PRT (log-rank, P < 0.001) while stage II did not (P = 0.095). The multivariate Cox proportional hazard model showed that PRT was an independent benefit factor in stage III rectal SRCC patients (HR, 0.611; 95% CI, 0.407–0.919; P = 0.018). In conclusion, SRCC was an independent predictor of poor prognosis in stage III RC patients, but not in stage II. In the PRT setting of locally advanced RC, SRCC patients had significantly worse prognosis. PRT was an independent prognostic factor associated with improved survival in stage III rectal SRCC.
Highlights
A total of 69,543 RC patients were included in this study and most patients were diagnosed with nonmucinous adenocarcinoma (NMC) (n = 63,036, 90.6%)
hazard ratios (HR), 0.611; 95% confidence intervals (CI), 0.407–0.919; P = 0.018). In this population based study, we analysed 69,543 locally advanced RC patients who were registered in the SEER. 0.9% of our population consisted of signet-ring cell carcinoma (SRCC), similar to the numbers reported in previous literatures concerning on all stages CRC5,9–11
SRCC has been associated with poor prognosis compared with common adenocarcinoma[9,20]
Summary
SRCC patients presented more frequently with stage III tumours than MC and NMC patients (79.4 vs 57.1%, 52.8%, P < 0.001, respectively) and poorer differentiation (P < 0.001). SRCC patients presented poorer 5 year survival than MC and NMC patients in both of stage II (43.60% vs 66.28% and 73.10%, P < 0.001, respectively) and III RC (34.55% vs 53.90% and 63.10%, P < 0.001, respectively). The higher age (>65 years), the larger tumour size (>5 cm), and poorly differentiated tumour grade were all significant factors that worsened survival in stage II and III RC (P < 0.001, respectively).
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