Department of Digestive and Oncological Surgery, Centre Hospitalier Régional Universitaire de Lille, University Hospital Claude Huriez, Place de Verdun, 59037, Lille cedex, France.
World J Surg. 2012 Feb;36(2):346-54. doi: 10.1007/s00268-011-1351-9.
Signet ring cell (SRC) carcinoma is defined as an adenocarcinoma in which >50% of the total operative specimen consists of isolated or small groups of malignant cells containing intracytoplasmic mucins (hSRCs). We previously demonstrated that hSRCs are a predictor of poor prognosis with specific tumoral characteristics suggesting the need for a dedicated therapeutic strategy before surgery. However diagnostic accuracy and prognostic value of SRCs on pretreatment biopsies (bSRCs) is unknown. The aim of the study was to determine if bSRCs can accurately predict hSRCs and survival.
A retrospective analysis was performed among 254 patients with an adenocarcinoma. We performed pretreatment endoscopic biopsies and histopathologic analysis of the surgical specimen. Pretreatment endoscopic biopsy results were compared with definitive pathologic results and were correlated with long-term survival.
From 254 patients enrolled, 96 had bSRCs (37.8%), and 101 (39.8%) had hSRCs. Pretreatment biopsy results were correct in 89 of 101 patients with hSRC (sensitivity 88.1%) and in 146 of 153 with histologic non-SRCs (hNSRCs) (specificity 95.4%). The positive and negative predictive values for the biopsies were 92.7, and 92.4%, respectively, with an overall accuracy of 92.5%. When compared to the biopsy results, non-SRCs (bNSRCs), bSRCs were associated with poorer survival and were identified as an independent factor for poor prognosis (hazard ratio 1.89 with 95% confidence interval 1.35 to 2.64, P < 0.001).
The presence of signet ring cells in samples obtained from routine pretreatment endoscopic biopsies accurately predicts SRC histology and poor prognosis. The specific therapeutic strategy can consequently be considered from the initial diagnosis.
印戒细胞癌（SRC）定义为腺癌，其中> 50％的总手术标本由含有细胞内黏蛋白的孤立或小群恶性细胞组成（hSRCs）。我们之前证明 hSRCs 是预后不良的预测因子，具有特定的肿瘤特征，表明在手术前需要专门的治疗策略。然而，预处理活检（bSRCs）中 SRCs 的诊断准确性和预后价值尚不清楚。本研究旨在确定 bSRCs 是否可以准确预测 hSRCs 和生存。
对 254 例腺癌患者进行回顾性分析。我们进行了预处理内镜活检和手术标本的组织病理学分析。将预处理内镜活检结果与明确的病理结果进行比较，并与长期生存相关。
在纳入的 254 例患者中，有 96 例有 bSRCs（37.8％），有 101 例有 hSRCs（39.8％）。在 101 例 hSRC 患者中，有 89 例（敏感性 88.1％）和 153 例非 hSRCs（hNSRCs）中 146 例（特异性 95.4％）的预处理活检结果正确。活检的阳性和阴性预测值分别为 92.7％和 92.4％，总准确率为 92.5％。与活检结果相比，非 SRCs（bNSRCs）与较差的生存相关，并被确定为预后不良的独立因素（危险比为 1.89，95％置信区间为 1.35 至 2.64，P <0.001）。
在常规预处理内镜活检中获得的样本中存在印戒细胞准确预测 SRC 组织学和不良预后。因此，可以从初始诊断开始考虑特定的治疗策略。
