Wang Renjie, Ma Xiaoji, Li Yaqi, He Yiping, Huang Dan, Cai Sanjun, Peng Junjie
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China.
PLoS One. 2016 Aug 10;11(8):e0160527. doi: 10.1371/journal.pone.0160527. eCollection 2016.
Signet ring cell carcinoma (SRCC) is rare. The aim of this study is to understand the clinicopathological features and identify the possible prognostic factors in colorectal SRCC.
Patients with SRCC who underwent primary lesion resection at Fudan University Shanghai Cancer Center from September 2008 to July 2014 were retrospectively analyzed. Patient's gender, age, tumor location, depth of invasion, lymph node metastasis, synchronous distant metastasis, perineural invasion, lymphovascular invasion, and E-cadherin expression were studied with prognosis, and the correlation between E-cadherin expression and clinicopathological features were analyzed. All clinicopathological and molecular factors were put into multivariate analysis using Cox proportional hazards model for detecting independent prognostic factors.
59 patients accounting for 0.89% of total colorectal cancer patients met the criteria and were enrolled in the study. The median survival time is 28.9 months, and the 3-year survival rate is 62.7%. SRCC were seen more common in young male patients. Advanced stage was more common in SRCC, 58 (98.3%) patients had T3/T4 lesions, 52 (88.1%) patients had lymph node metastasis, and 14 (23.7%) patients had distant metastasis. Distant metastases were seen more common in peritoneal cavity. Distant metastasis (HR = 4.194, 95% CI: 1.297-13.567), lymphovascular invasion (HR = 2.888, 95% CI: 1.115-7.483), and E-cadherin expression (HR = 0.272, 95% CI: 0.096-0.768) were independent predictors for survival.
SRCC is a rare subtype of colorectal cancer with poor prognosis. Distant metastasis, lymphovascular invasion, and E-cadherin expression can predict prognosis of colorectal SRCCs independently. More precise therapy and more close surveillance are needed for these patients.
印戒细胞癌（SRCC）较为罕见。本研究旨在了解结直肠SRCC的临床病理特征并确定可能的预后因素。
回顾性分析2008年9月至2014年7月在复旦大学附属上海肿瘤医院接受原发性病灶切除的SRCC患者。研究患者的性别、年龄、肿瘤位置、浸润深度、淋巴结转移、同时性远处转移、神经周围浸润、淋巴管浸润和E-钙黏蛋白表达与预后的关系，并分析E-钙黏蛋白表达与临床病理特征之间的相关性。将所有临床病理和分子因素纳入Cox比例风险模型进行多变量分析，以检测独立的预后因素。
59例患者符合标准，占结直肠癌患者总数的0.89%，纳入本研究。中位生存时间为28.9个月，3年生存率为62.7%。SRCC在年轻男性患者中更为常见。SRCC中晚期更为常见，58例（98.3%）患者有T3/T4病变，52例（88.1%）患者有淋巴结转移，14例（23.7%）患者有远处转移。远处转移在腹腔中更为常见。远处转移（HR = 4.194，95%CI：1.297 - 13.567）、淋巴管浸润（HR = 2.888，95%CI：1.115 - 7.483）和E-钙黏蛋白表达（HR = 0.272，95%CI：0.096 - 0.768）是生存的独立预测因素。
SRCC是结直肠癌的一种罕见亚型，预后较差。远处转移、淋巴管浸润和E-钙黏蛋白表达可独立预测结直肠SRCC的预后。这些患者需要更精确的治疗和更密切的监测。
