Fadel Michael G, Malietzis George, Constantinides Vasilis, Pellino Gianluca, Tekkis Paris, Kontovounisios Christos
Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.
Department of Surgery and Cancer, Imperial College, London, UK.
Discov Oncol. 2021 Feb 22;12(1):5. doi: 10.1007/s12672-021-00398-6.
Histological subtypes of colorectal cancer may be associated with varied prognostic features. This systematic review and meta-analysis aimed to compare clinicopathological characteristics, recurrence and overall survival between colorectal signet-ring cell (SC) and mucinous carcinoma (MC) to conventional adenocarcinoma (AC).
A literature search of MEDLINE, EMBASE, Ovid and Cochrane Library was performed for studies that reported data on clinicopathological and survival outcomes on SC and/or MC versus AC from January 1985 to May 2020. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed.
Thirty studies of 1,087,055 patients were included: 11,510 (1.06%) with SC, 110,179 (10.13%) with MC and 965,366 (88.81%) with AC. Patients with SC were younger than patients with AC (WMD - 0.47; 95% CI - 0.84 to -0.10; I 88.6%; p = 0.014) and more likely to have right-sided disease (OR 2.12; 95% CI 1.72-2.60; I 82.9%; p < 0.001). Locoregional recurrence at 5 years was more frequent in patients with SC (OR 2.81; 95% CI 1.40-5.65; I 0.0%; p = 0.004) and MC (OR 1.92; 95% CI 1.18-3.15; I 74.0%; p = 0.009). 5-year overall survival was significantly reduced when comparing SC and MC to AC (HR 2.54; 95% CI 1.98-3.27; I 99.1%; p < 0.001 and HR 1.38; 95% CI 1.19-1.61; I 98.6%; p < 0.001, respectively).
SC and MC are associated with right-sided lesions, advanced stage at presentation, higher rates of recurrence and poorer overall survival. This has strong implications towards surgical and oncological management and surveillance of colorectal cancer.
结直肠癌的组织学亚型可能与不同的预后特征相关。本系统评价和荟萃分析旨在比较结直肠印戒细胞癌（SC）和黏液腺癌（MC）与传统腺癌（AC）的临床病理特征、复发情况和总生存率。
对MEDLINE、EMBASE、Ovid和Cochrane图书馆进行文献检索，以查找1985年1月至2020年5月期间报告SC和/或MC与AC的临床病理和生存结果数据的研究。使用随机效应模型进行荟萃分析，并评估研究间的异质性。
纳入了30项研究，共1,087,055例患者：11,510例（1.06%）为SC，110,179例（10.13%）为MC，965,366例（88.81%）为AC。SC患者比AC患者年轻（加权均数差-0.47；95%可信区间-0.84至-0.10；I²88.6%；p=0.014），且更易发生右侧病变（比值比2.12；95%可信区间1.72-2.60；I²82.9%；p<0.001）。SC患者（比值比2.81；95%可信区间1.40-5.65；I²0.0%；p=0.004）和MC患者（比值比1.92；95%可信区间1.18-3.15；I²74.0%；p=0.009）5年局部复发更为常见。与AC相比，SC和MC的5年总生存率显著降低（风险比2.54；95%可信区间1.98-3.27；I²99.1%；p<0.001和风险比1.38；95%可信区间1.19-1.61；I²98.6%；p<0.001）。
SC和MC与右侧病变、就诊时分期较晚、较高的复发率和较差的总生存率相关。这对结直肠癌的手术、肿瘤管理和监测具有重要意义。
