结肠印戒细胞癌和黏液腺癌的临床结局

Clinical outcome of signet ring cell carcinoma and mucinous adenocarcinoma of the colon.

作者信息

Chen Jinn-Shiun, Hsieh Pao-Shiu, Chiang Jy-Ming, Yeh Chien-Yuh, Tsai Wen-Sy, Tang Reiping, Changchien Chung-Rong, Wu Ren-Chin

机构信息

Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

出版信息

Chang Gung Med J. 2010 Jan-Feb;33(1):51-7.

PMID:20184795

Abstract

BACKGROUND

The purpose of this study was to evaluate the clinicopathologic features and prognosis of signet ring cell carcinoma (SCC) and non-SCC mucinous adenocarcinoma (MC) and to compare them with those of nonmucinous adenocarcinoma (NMC) of the colon.

METHODS

From January 1995 to December 2003, 45 patients with SCC and 332 with MC were identified from prospectively collected medical records. The clinical data and outcomes were compared with those of 2984 consecutive patients with NMC in the same period.

RESULTS

The mean age at onset of SCC was 54.3 years. This was significantly lower than those for MC (mean 59.5 years, p = 0.038) and NMC (62.4 years, MC vs. NMC, p < 0.01). The rate of spread of tumors in TNM stage IV via hematogenous routes (liver, lung, bone, and brain) was significantly lower in SCC patients (5/28, 17.9%) than in MC (40/104, 38.5%) and in NMC patients (417/694, 60.1%). The rate of tumor spread via lymphatic drainage (systemic node) or seeding to the peritoneum was higher in SCC (23/28, 82.1%) and MC patients (79/104, 76.0%), than in NMC patients (343/694, 49.4%, p < 0.001). There was a higher proportion of poorly differ-entiated tumors in SCC (32/42, 71.1%) than in MC (26/332, 7.8%) and NMC (203/2984, 6.8%). The 1-, 2-, and 5-year overall survival rates of patients with SCC were 77.8%, 26.7%, and 11.9%, of those with MC, 81.6%, 65.9%, and 49.4% and of those with NMC, 84.1%, 73.3%, and 58.7%, respectively.

CONCLUSION

The prognosis of SCC is poorer than that of MC and NMC. SCC patients had more locally advanced and almost no early-detected tumors, less hematogenic spread, and very poor surgical outcomes. The role of resection for late stage SCC should be carefully evaluated.

摘要

背景

本研究旨在评估印戒细胞癌（SCC）和非SCC黏液腺癌（MC）的临床病理特征及预后，并将它们与结肠非黏液腺癌（NMC）进行比较。

方法

1995年1月至2003年12月，从前瞻性收集的病历中确定了45例SCC患者和332例MC患者。将临床数据和结果与同期连续的2984例NMC患者进行比较。

结果

SCC发病的平均年龄为54.3岁。这显著低于MC（平均59.5岁，p = 0.038）和NMC（62.4岁，MC与NMC比较，p < 0.01）。SCC患者中肿瘤通过血行途径（肝、肺、骨和脑）在TNM IV期的扩散率（5/28，17.9%）显著低于MC（40/104，38.5%）和NMC患者（417/694，60.1%）。SCC（23/28，82.1%）和MC患者（79/104，76.0%）中肿瘤通过淋巴引流（全身淋巴结）或种植到腹膜的扩散率高于NMC患者（343/694，49.4%，p < 0.001）。SCC中低分化肿瘤的比例（32/42，71.1%）高于MC（26/332，7.8%）和NMC（203/2984，6.8%）。SCC患者1年、2年和5年的总生存率分别为77.8%、26.7%和11.9%，MC患者分别为81.6%、65.9%和49.4%，NMC患者分别为84.1%、73.3%和58.7%。