Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan.
Department of Internal Medicine, Lo-Sheng Sanatorium and Hospital Ministry of Health and Welfare, New Taipei, Taiwan.
BMC Gastroenterol. 2022 Apr 8;22(1):173. doi: 10.1186/s12876-022-02258-1.
Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is rare, usually diagnosed at advanced stage with poor outcomes. We aimed to find possible diagnostic clues in order to help diagnosis.
A retrospective study of PSRCCR patients from 1993 to 2018 was reviewed at a single tertiary center. Colorectal adenocarcinoma patients as control group with 1:4 ratio was also enrolled.
18 patients with PSRCCR were identified. The prevalence rate was 0.16% (18 of 11,515). The mean age was 50.2 years-old in PSRCCR group and 63 years-old in non-SRCC colorectal cancer patients (p < 0.001). Diagnosis tool depends on colonoscopy were much less in PSRCCR group than control group (44.4% vs 93%, p < 0.001). SRCC patients had higher level of CEA (68.3 vs 17.7 ng/mL, p = 0.004) and lower level of Albumin (3.4 vs 4.3 g/dL, p < 0.001). The majority of PSRCCR tumor configuration was ulcerative and infiltrative. More PSRCCR pathology presented as high-grade carcinoma (66.7 vs 1.4%, p < 0.001) and lymphovascular invasion (77.8 vs 44.4%, p = 0.011) than control group. More PSRCCR patients were diagnosed at advanced stage (88.8 vs 40.3%, p = 0.001). Higher mortality was also noticed in PSRCCR group than control group (72.2 vs 20.8%, p < 0.001).
For young patients with long segment colonic stenosis and ulcerative/ infiltrative mucosa but endoscopic biopsy failed to identify malignant cells, earlier operation or non-colon site biopsy is suggested for diagnosing the PSRCCR.
结肠和直肠原发性印戒细胞癌（PSRCCR）较为罕见，通常在晚期诊断，预后较差。我们旨在寻找可能的诊断线索以协助诊断。
对单一三级中心 1993 年至 2018 年的 PSRCCR 患者进行回顾性研究。同时纳入了 1:4 比例的结直肠腺癌患者作为对照组。
共发现 18 例 PSRCCR 患者，发病率为 0.16%（11515 例中的 18 例）。PSRCCR 组的平均年龄为 50.2 岁，而非 SRCC 结直肠癌患者的平均年龄为 63 岁（p<0.001）。PSRCCR 组诊断工具主要依赖结肠镜检查的比例明显低于对照组（44.4% vs 93%，p<0.001）。SRCC 患者的 CEA 水平更高（68.3 vs 17.7ng/mL，p=0.004），白蛋白水平更低（3.4 vs 4.3g/dL，p<0.001）。PSRCCR 肿瘤的大多数形态为溃疡性和浸润性。PSRCCR 组的高级别癌（66.7 vs 1.4%，p<0.001）和血管淋巴管浸润（77.8 vs 44.4%，p=0.011）的比例明显高于对照组。PSRCCR 患者更多处于晚期（88.8 vs 40.3%，p=0.001）。PSRCCR 组的死亡率也明显高于对照组（72.2 vs 20.8%，p<0.001）。
对于年轻患者，若存在长段结肠狭窄和溃疡性/浸润性黏膜，但内镜活检未能识别恶性细胞，建议早期手术或非结肠部位活检以诊断 PSRCCR。
