The Predictive and Guidance Value of Signet Ring Cell Histology for Stage II/III Colon Cancer Response to Chemotherapy.

Huici Jiang,Yupeng Wu,Peiyu Zhao,Dongxuan Shao

doi:10.3389/fonc.2021.631995

Abstract

PurposeTo evaluate the predictive and guidance value of signet-ring cell carcinoma for chemotherapy response in stage II/III colon cancer.MethodsEligible patients were recruited from the Surveillance, Epidemiology and End Results (SEER) database. The differences between adenocarcinoma (AD) and SRCC groups in the incidence of patients’ demographic and clinical characteristics were analyzed by Pearson’s chi-squared (×2) test. Survival was analyzed using the Kaplan–Meier method, and the differences were determined by the log-rank test. Some Cox regression models were built to assess hazard ratios (HRs) of different variables with 95% confidence intervals (95% CIs).ResultsIn stage II AD, it was found that the receipt of chemotherapy had significantly 12.6% decreased risk of cancer-specific mortality (HR = 0.874, 95% CI = 0.825–0.927, P < 0.001). In stage II SRCC, however, the receipt of chemotherapy had significantly 70.00% increased risk of cancer-specific mortality (HR = 1.700, 95% CI = 1.032–2.801, P = 0.037). In stage III AD, it was found that the receipt of chemotherapy had significantly 45.3% decreased risk of cancer-specific mortality (HR = 0.547, 95% CI = 0.530–0.564, P < 0.001). In stage III SRCC, the receipt of chemotherapy had significantly 24.6% decreased risk of cancer-specific mortality (HR = 0.754, 95% CI = 0.632–0.900, P = 0.002).ConclusionsThe cancer-specific survival (CSS) difference between AD and SRCC was not statistically significant in stage II colon cancer. We provided the first compelling evidence that chemotherapy should not be treated in stage II SRCC, while stage III SRCC should be treated with chemotherapy.

Highlights

Colon cancer is one of the most common malignant tumors in clinical practice and among the leading causes of cancer-related deaths all over the world [1]
A total of 142,983 patients diagnosed with stage II/III colon cancer were recruited from the SEER database, including 141,281 patients (98.8%) with AC and 1,702 patients (1.2%) with Signetring cell carcinoma (SRCC), 72,796 patients (50.9%) with stage II disease, and 70,187 patients (49.1%) with stage III disease, 69,248 males (48.4%) and 73,735 females (51.6%), most of them were white (80.4%)
It was found that SRCC histology was more likely to be related to T4 stage (P < 0.001), N2 stage (P < 0.001), and grade III/IV (P < 0.001), indicating that SRCC histology was more likely to be associated with adverse tumor pathology

Summary

Introduction

Colon cancer is one of the most common malignant tumors in clinical practice and among the leading causes of cancer-related deaths all over the world [1]. SRCC had a distinct histologic appearance and underlying biologic behavior and some researchers reported that SRCC had higher pattern of peritoneal and ovarian metastasis and worse prognosis compared with AD [4, 5, 7,8,9,10]. It is still unclear whether SRCC would influence clinical decision-making with the aggressive behavior [11,12,13]. Stage II colon cancer with high-risk factors (including T4 status, poorly differentiated histology, vascular invasion, ileus,

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