Adverse Histological Features Alone Was Not Sufficient for Decision of Adjuvant Chemotherapy in T3N0M0 colonic cancer: A Propensity Score Matching Study Based on Population Analysis

Abstract Purpose: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide. Approximately 25% of patients with AJCC stage II suffered recurrence after radical surgery, but the role of adjuvant chemotherapy in Stage II CRC is controversial. We aimed to evaluate the benefit from chemotherapy for T3N0M0 patients with adverse histological features. Methods: An analysis of the Surveillance, Epidemiology, and End Results (SEER) 18 databases was performed to identify patients underwent radical resection 20-80 years old with colonic carcinoma diagnosed during year 2004 to 2012. Poorly differentiated, undifferentiated, mucinous adenocarcinoma and signet ring cell carcinoma (SRCC) were defined as adverse histological features, and well or moderately differentiated adenocarcinoma as good histological features. Multivariate analyses were used to adjust the effects of other covariates. The survival benefit of adjuvant chemotherapy was demonstrated in the propensity score matching cohort. Results: The adjuvant chemotherapy brought no survival benefit (good histological features HR, 1.076; 95% CI, 0.957-1.211; P=0.220; adverse histological features HR, 0.995; 95% CI, 0.777-1.274; P=0.967); Neither mucinous adenocarcinoma nor signet ring cell carcinoma brought a significance on survival (mucinous adenocarcinoma HR, 0.699; 95% CI, 0.488-1.002; P=0.051; signet ring cell carcinoma HR, 0.750; 95% CI, 0.386-1.459; P=0.397) compared to adenocarcinoma. Left-side colon was associated with a poorer survival in good histological features group (HR, 1.136; 95% CI, 1.034-1.248; P=0.008). Conclusions: The adverse histological features don’t influence on survival for patients with T3N0M0 staging, and adjuvant chemotherapy is invalid to improve the survival for these patients, indicating adverse histological features alone was not sufficient for decision of adjuvant chemotherapy in this situation rather than the recommendation of the guidelines.

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Primary signet ring cell carcinoma of colon: Retrospective analysis of VACCR database.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.58 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 58-58 ◽

Cited By ~ 1

Author(s):

R. Thota ◽

T. Tashi ◽

W. Gonsalves ◽

V. Murukesan ◽

P. Townley ◽

...

Keyword(s):

Lymph Node ◽

Cell Carcinoma ◽

Mucinous Adenocarcinoma ◽

Cell Cancer ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Lymph Node Status ◽

Signet Ring ◽

Ring Cell ◽

Carcinoma Of Colon

58 Background: Signet ring cell carcinoma accounts for less than 1% of all colon cancers. We examined the clinical pathological features and prognosis of signet ring cell carcinoma of colon and compare it with mucinous and non-mucinous adenocarcinoma of colon. Methods: A total of 206 patients diagnosed with signet ring cell carcinoma from 1995 to 2009 were identified from the VA Central Cancer Registry (VACCR) database. Age, race, histology, grade, lymph node status, stage and type of treatment received data were collected. Results: Out of 206 patients, 173 (83.9%) were white, 31 (15%) were black, and 2 patients were listed as unknown. Median age of diagnosis was 67 years as compared to 70 years for both mucinous and non-mucinous adenocarcinoma of colon. Pathological T-stages were as follows: T1 = 2.9%, T2=5.3%, T3=33.9%, T4= 25.7%, and unknown 32%. Of the total, 22.3% were located in caecum, 21.8% in ascending colon, 15.5% in sigmoid colon, 7.7% in appendix and hepatic flexure of colon, 11.1% in transverse colon, 2.9% in splenic flexure and 4.4% in descending colon. 33.5% were lymph node positive, 34.6% were lymph node negative, and 31.8% were unknown. Histologically grade 3 (55.4%) was most commonly reported followed by grade 2 (7.3%), grade 1 (2.5%), grade 4 (1.9%)and in 33% grade was unknown. 41.3% patients received only surgery while 34% received surgery with adjuvant chemotherapy, 7.3% received chemotherapy alone and 7.8% patients received either chemotherapy, radiation or hormonal therapy alone, 9% did not receive any therapy. 1 year, 3 year and 5 year survivals for signet ring cell cancer compared to adeno carcinoma was 60% vs 80%, 33% vs 60%, and 24% vs 47% respectively. Median survival of signet ring cell carcinoma compared to mucinous and non mucinous adenocarcinoma was 19 months, 48 months and 62 months respectively. Conclusions: Signet ring cell carcinoma of colon has poor survival rates than the other histological subtypes. Signet ring cell carcinoma presents at an earlier age, higher tumor grade and advanced stage at diagnosis when compared to mucinous and non-mucinous adenocarcinoma of colon. Due to rarity of this disease further multi-institute studies are required for in-depth understanding and analysis of this disease. No significant financial relationships to disclose.

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Colorectal signet-ring cell carcinoma: Responsive to adjuvant chemotherapy but still a poor prognosis.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.529 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 529-529

Author(s):

Niek Hugen ◽

Rob H. A. Verhoeven ◽

Valery E. P. P. Lemmens ◽

Carola J. C. Van Aart ◽

Marloes A. G. Elferink ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Cell Carcinoma ◽

Treatment Guidelines ◽

Relative Survival ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Prognostic Impact ◽

Colon And Rectal Cancer ◽

Signet Ring ◽

Ring Cell

529 Background: Colorectal signet-ring cell carcinoma (SRCC) has been associated with a poor survival compared to mucinous adenocarcinoma (MC) and the common adenocarcinoma (AC). Prognostic impact of tumor localization is unknown and efficacy of adjuvant chemotherapy in SRCC has never been assessed. This study analyses prognostic impact of SRCC and determines whether SRCC patients benefit from adjuvant chemotherapy for colon cancer equally compared with AC. Methods: Data on 196,757 patients with CRC in the Netherlands in the period 1989 and 2010 was included in this 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. Results: SRCC was found in 1.0% of CRC patients. SRCC patients presented more frequently with stage III or IV disease than AC (75.2% versus 43.6%, P<0.0001) and SRCC was more frequently found in the proximal colon (57.7% versus 32.0%, P<0.0001). SRCC patients had a poor 5-year relative survival of 31% in colon and 20% in the rectum compared to 57% and 59% in AC (P<0.0001). This poorer survival for SRCC was found in stage II, III and IV. In comparison 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. Conclusions: Prognostic impact of SRCC is dismal in both colon and rectal cancer patients, but colonic SRCC patients seem to benefit from adjuvant chemotherapy equally compared with AC. Reduced efficacy of adjuvant chemotherapy therefore does not seem to explain the poor outcome in SRCC patients. We recommend to adhere to adjuvant treatment guidelines for all histological subtypes, but encourage clinical trials to take histological subtype into account for stratification.

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

International Journal of Cancer ◽

10.1002/ijc.28981 ◽

2014 ◽

Vol 136 (2) ◽

pp. 333-339 ◽

Cited By ~ 46

Author(s):

Niek Hugen ◽

Rob H. Verhoeven ◽

Valery E Lemmens ◽

Carola J. van Aart ◽

Marloes A. Elferink ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Prognostic Factor ◽

Cell Carcinoma ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Poor Prognostic Factor ◽

Signet Ring ◽

Ring Cell

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The difference in clinic-pathological features between signet ring cell carcinoma and gastric mucinous adenocarcinoma

Tumor Biology ◽

10.1007/s13277-013-0812-1 ◽

2013 ◽

Vol 34 (5) ◽

pp. 2625-2631 ◽

Cited By ~ 10

Author(s):

Hao Jiang ◽

Hongfeng Zhang ◽

Lantian Tian ◽

Xi Zhang ◽

Yingwei Xue

Keyword(s):

Cell Carcinoma ◽

Mucinous Adenocarcinoma ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Pathological Features ◽

Signet Ring ◽

Ring Cell ◽

The Difference

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Clinical Characteristics and Prognostic Analysis of Patients With Signet Ring Cell Gastric Carcinoma

Technology in Cancer Research & Treatment ◽

10.1177/1533033820983812 ◽

2020 ◽

Vol 19 ◽

pp. 153303382098381

Author(s):

Jia Mi Yu ◽

Zhou Wei Zhan ◽

Jing Xian Zhen ◽

Xiao Jie Wang ◽

Yu Chen ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Adjuvant Chemotherapy ◽

Cell Carcinoma ◽

Gastroesophageal Junction ◽

Tumor Stage ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Signet Ring ◽

Ring Cell

We do not know the clinical and prognostic factors that influence the survival of patients with gastric signet ring cell carcinoma (SRC). Therefore, a retrospective review was undertaken of 219 patients with SRC who had undergone gastrectomy between January 2009 and December 2012 in our hospital. Patient age, sex, TNM stage, vessel carcinoma embolus, perineural invasion, tumor site and operation type, postoperative chemotherapy, and five-year overall survival were recorded and evaluated. In our study, 93 cases (42.5%) were signet ring cell carcinoma only, and 126 cases (57.5%) were signet ring cell carcinoma coexisting with other components (such as adenocarcinoma or mucus adenocarcinoma). Eighty-three patients were female, 136 were male, 46 occurred at the gastroesophageal junction (21.0%), 63 at the fundus/body (28.8%), 80 were antrum/pylorus (36.5%), and 30 were whole stomach (13.7%). The prognosis of gastric antrum/ pylorus cancer was the best (P < 0.05). There were 133 patients (60.7%) with stage III, and the single factor analysis showed that the earlier the stage, the better the prognosis. The overall five-year survival rate was 30.1% in all patients. One-hundred and 41 patients (64.4%) received D2 radical surgery, 64 (29.2%) received D1 radical operation, and 14 (6.4%) received palliative resection, and the patients who received D2 had the best overall survival (P < 0.05). The survival time of the paclitaxel-based regimen in postoperative adjuvant chemotherapy tended to be prolonged. There was no statistical difference in overall survival between the percentage of signet-ring cells and sex. In summary, age, tumor stage, and surgical resection combined with D2 lymphadenectomy were independent prognostic factors for SRC. Adjuvant chemotherapy with a paclitaxel-based regimen may improve the survival of patients with SRC.

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Long-Term Survival of a Patient with Invasive Signet-Ring Cell Carcinoma of the Urinary Bladder Managed by Combined S-1 and Cisplatin Adjuvant Chemotherapy

Case Reports in Urology ◽

10.1155/2013/915874 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Takashi Hamakawa ◽

Yoshiyuki Kojima ◽

Taku Naiki ◽

Yasue Kubota ◽

Takahiro Yasui ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Urinary Bladder ◽

Cell Carcinoma ◽

Radical Cystectomy ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Term Survival ◽

Signet Ring ◽

Ring Cell

Primary signet-ring cell carcinoma of the urinary bladder is extremely rare and patient survival is very poor. The disease usually presents at advanced stages because the cancer progresses rapidly. The only option for effective treatment is radical cystectomy, and no effective chemotherapy has been established for this variant. We report a case of signet-ring cell carcinoma of the urinary bladder with a long-term survival of 90 months owing to radical cystectomy and combination adjuvant chemotherapy with S-1 and cisplatin. To our knowledge, this is the first report to demonstrate the long-term therapeutic activity of combination S-1 and cisplatin adjuvant chemotherapy against invasive signet-ring cell carcinoma of the urinary bladder.

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