Chen Jinn-Shiun, Hsieh Pao-Shiu, Hung Shin-Yuan, Tang Reiping, Tsai Wen-Sy, Changchien Chung-Rong, Lin Paul-Yann, Wang Jeng-Yi, Yeh Chien-Yuh
Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan.
Int J Colorectal Dis. 2004 Mar;19(2):102-7. doi: 10.1007/s00384-003-0515-y. Epub 2003 Jul 23.
Signet ring cell carcinoma of the rectum (SCCR) is a rare type of rectal carcinoma. This study examined the clinical significance of SCCR.
From our medical records we retrospectively identified 61 SCCR patients and compared their clinical data and outcomes to those of 144 consecutive patients with non-SCCR mucinous rectal adenocarcinomas (NSMR) and 2,414 consecutive patients with nonmucinous rectal adenocarcinomas (NMR).
. The incidence of SCCR was 1.39% of rectal cancers. Mean patient age at onset of SCCR (48.1years, range 15-80) was significantly lower than that for NSMR (57.4 years, 9-88) and NMR (62.6 years, 12-94). The proportion of late stage (TNM III+IV) tumors was significantly higher in SCCR (90%) than in NSMR (69%) and NMR (48%). There were more tumors located in the lower rectum in SCCR (46%) than in NSMR (34%) and NMR (29%). SCCR tumors were significantly larger (5.68+/-3.84 cm) than NSMR (4.27+/-1.78 cm) and NMR tumors (3.76+/-1.71 cm). A higher percentage of patients with SCCR (42.6%) received abdominoperineal resection for treatment. In tumors with TNM stage IV the rate of tumor spread via the hematogenous route was significantly lower in SCCR (18.5%) than in NSMR (43.5%) and in NMR (69%). The rate of tumor spread via seeding to the peritoneum was lower in SCCR (22.2%) than in NSMR (43.5%) but higher than in NMR (2.7%). The rate of tumor spread via the lymphatic route was higher in SCCR (44.4%) than in NSMR (26.1%) and significantly higher than in NMR (12.3%). The 1-, 2-, and 5-year overall SCCR survival rates were 73.9%, 36.3%, and 23.3% respectively, which were significantly poorer than those of NSMR and NMR. For the 28 stage III and R0 SCCR tumors the 1-, 2-, and 5-year disease-free survival rates of SCCR were 84.0%, 44.2%, and 30.3%, respectively, which are comparable with general data of stage III rectal cancer in the world.
Diffuse infiltration of signet ring cells enhances the tendency of mucinous carcinomas of the rectum in more local extension and easier lymphatic spreading but not at peritoneal seeding. Although SCCR had the poorest prognosis, this outcome may be due to the advanced tumor stage rather than histology itself.
直肠印戒细胞癌（SCCR）是一种罕见的直肠癌类型。本研究探讨了SCCR的临床意义。
我们从病历中回顾性确定了61例SCCR患者，并将他们的临床数据和结局与144例连续的非SCCR黏液性直肠腺癌（NSMR）患者以及2414例连续的非黏液性直肠腺癌（NMR）患者进行比较。
SCCR的发病率占直肠癌的1.39%。SCCR发病时的平均患者年龄（48.1岁，范围15 - 80岁）显著低于NSMR（57.4岁，9 - 88岁）和NMR（62.6岁，12 - 94岁）。晚期（TNM III + IV期）肿瘤在SCCR中的比例（90%）显著高于NSMR（69%）和NMR（48%）。SCCR中位于直肠下段的肿瘤（46%）比NSMR（34%）和NMR（29%）更多。SCCR肿瘤（5.68±3.84 cm）显著大于NSMR（4.27±1.78 cm）和NMR肿瘤（3.76±1.71 cm）。更高比例的SCCR患者（42.6%）接受了腹会阴联合切除术治疗。在TNM IV期肿瘤中，SCCR经血行转移的肿瘤扩散率（18.5%）显著低于NSMR（43.5%）和NMR（69%）。SCCR经种植转移至腹膜的肿瘤扩散率（22.2%）低于NSMR（43.5%）但高于NMR（2.7%）。SCCR经淋巴途径转移的肿瘤扩散率（44.4%）高于NSMR（26.1%）且显著高于NMR（12.3%）。SCCR的1年、2年和5年总生存率分别为73.9%、36.3%和23.3%，显著低于NSMR和NMR。对于28例III期且R0切除的SCCR肿瘤，SCCR的1年、2年和5年无病生存率分别为84.0%、44.2%和30.3%，与世界范围内III期直肠癌的一般数据相当。
印戒细胞的弥漫浸润增强了直肠黏液癌在局部更广泛扩展和更容易发生淋巴转移的倾向，但在腹膜种植方面并非如此。尽管SCCR的预后最差，但这种结果可能是由于肿瘤分期较晚而非组织学本身所致。
