Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China.
Sci Rep. 2017 Mar 27;7:45334. doi: 10.1038/srep45334.
As well known, signet-ring cell carcinoma (SRCC) is a rare histological subtype of colorectal adenocarcinoma, which has been associated with poor prognosis and resistant to non-surgery therapy compared with common adenocarcinoma. In this study, we assessed the effect of preoperative radiotherapy (PRT) for locally advanced rectal SRCC in a large patient group from the Surveillance, Epidemiology, and End Results program (SEER, 1988-2011) database. SRCC was found in 0.9% (n = 622) rectal cancer (RC) patients in our study. In the PRT setting, SRCC had significantly worse cancer-specific survival than mucinous adenocarcinoma and nonmucinous adenocarcinoma patients (log-rank, P < 0.001). In terms of SRCC, stage III RC patients benefited from PRT (log-rank, P < 0.001) while stage II did not (P = 0.095). The multivariate Cox proportional hazard model showed that PRT was an independent benefit factor in stage III rectal SRCC patients (HR, 0.611; 95% CI, 0.407-0.919; P = 0.018). In conclusion, SRCC was an independent predictor of poor prognosis in stage III RC patients, but not in stage II. In the PRT setting of locally advanced RC, SRCC patients had significantly worse prognosis. PRT was an independent prognostic factor associated with improved survival in stage III rectal SRCC.
众所周知，印戒细胞癌（SRCC）是结直肠腺癌中一种罕见的组织学亚型，与普通腺癌相比，其预后较差，对非手术治疗具有耐药性。在这项研究中，我们评估了术前放疗（PRT）对来自监测、流行病学和最终结果（SEER，1988-2011 年）数据库中大量局部晚期直肠 SRCC 患者的疗效。我们的研究中，0.9%（n=622）的直肠肿瘤（RC）患者为 SRCC。在 PRT 治疗中，SRCC 的癌症特异性生存率明显低于黏液腺癌和非黏液腺癌患者（对数秩检验，P<0.001）。在 SRCC 方面，III 期 RC 患者从 PRT 中获益（对数秩检验，P<0.001），而 II 期患者则没有（P=0.095）。多变量 Cox 比例风险模型显示，PRT 是 III 期直肠 SRCC 患者的独立获益因素（HR，0.611；95%CI，0.407-0.919；P=0.018）。总之，SRCC 是 III 期 RC 患者预后不良的独立预测因素，但不是 II 期患者。在局部晚期 RC 的 PRT 治疗中，SRCC 患者的预后明显较差。PRT 是与 III 期直肠 SRCC 患者生存改善相关的独立预后因素。
