Song Wu, Wu Sui-jing, He Yu-long, Cai Shi-rong, Zhang Chang-hua, Zhang Xin-hua, Zhan Wen-hua
Department of Gastrointestinal-pancreatic Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 501800, China.
Chin Med J (Engl). 2009 Jul 5;122(13):1486-91.
Previous studies have shown conflicting results on the relation between clinicopathologic features and prognosis of patients with colorectal mucinous, signet-ring cell, or non-mucinous adenocarcinoma; only few such studies have been performed in China. This retrospective study analyzed data from our department to investigate clinicopathologic characteristics, prognosis and possible correlations of three histologic types - colorectal mucinous, signet-ring cell, and non-mucinous adenocarcinoma, to clarify the bases for observed differences which may lead to development of targeted therapies.
Of 2079 patients diagnosed with colorectal cancer between 1994 and 2007, 144 had mucinous, 25 had signet-ring cell, and 1837 had non-mucinous adenocarcinoma. Their clinicopathologic parameters and survival were analyzed using established statistical methodologies.
Mucinous and signet-ring cell adenocarcinomas were common in younger patients (P < 0.001). Location, size and disease stage differed significantly among the three types. Signet-ring cell tumors were more commonly found in the rectum than mucinous and non-mucinous adenocarcinoma (P < 0.001). Mucinous and signet-ring cell tumors presented in a later stage in life more often than non-mucinous adenocarcinoma, with lymph node involvement, serosal infiltration, peritoneal dissemination, and adjacent organ invasion (P < 0.01). The rate of radical resection, hepatic metastasis and local recurrence did not differ among types (P > 0.05). Compared with patients with non-mucinous adenocarcinoma, patients with mucinous and signet-ring cell tumors who underwent potentially curative resections or stage II/III disease had poorer long-term overall survival. Survival did not differ by type for patients with either stage I or IV disease (P > 0.05).
Mucinous and signet-ring cell adenocarcinoma have unique carcinogenesis and similar biologic behavior. Our study confirms that both histologic types, especially signet-ring cell tumors, are independent, negative prognostic factors for patients with colorectal cancer. Type does not appear to have a significant effect on survival when disease is either stage I or IV at presentation.
既往研究在结直肠黏液腺癌、印戒细胞癌或非黏液腺癌患者的临床病理特征与预后的关系上得出了相互矛盾的结果；在中国，此类研究开展较少。本回顾性研究分析了我科室的数据，以调查结直肠黏液腺癌、印戒细胞癌和非黏液腺癌这三种组织学类型的临床病理特征、预后及可能的相关性，从而明确观察到的差异的基础，这些差异可能会促成靶向治疗的发展。
在1994年至2007年间诊断为结直肠癌的2079例患者中，144例为黏液腺癌，25例为印戒细胞癌，1837例为非黏液腺癌。使用既定的统计方法分析他们的临床病理参数和生存情况。
黏液腺癌和印戒细胞癌在年轻患者中更为常见（P < 0.001）。三种类型在肿瘤位置、大小和疾病分期方面存在显著差异。印戒细胞肿瘤在直肠中的发生率高于黏液腺癌和非黏液腺癌（P < 0.001）。与非黏液腺癌相比，黏液腺癌和印戒细胞肿瘤在晚期出现的频率更高，伴有淋巴结转移、浆膜浸润、腹膜播散和邻近器官侵犯（P < 0.01）。三种类型的根治性切除率、肝转移率和局部复发率无差异（P > 0.05）。与非黏液腺癌患者相比，接受了潜在根治性切除或处于II/III期疾病的黏液腺癌和印戒细胞肿瘤患者的长期总生存率较差。对于I期或IV期疾病的患者，生存率在各类型之间无差异（P > 0.05）。
黏液腺癌和印戒细胞癌具有独特的致癌机制和相似的生物学行为。我们的研究证实，这两种组织学类型，尤其是印戒细胞肿瘤，是结直肠癌患者独立的不良预后因素。当疾病在初诊时为I期或IV期时，组织学类型似乎对生存没有显著影响。
