Signet-Ring Cell Carcinoma as an Independent Prognostic Factor for Patients With Urinary Bladder Cancer: A Population-Based Study

Abstract

Background: Primary signet-ring cell carcinoma (SRCC) is a rare variation of adenocarcinoma. Although SRCC of the urinary bladder is highly malignant, it is often neglected due to its rarity. Materials and Methods: We used the national Surveillance, Epidemiology, and End Results (SEER) database (2004-2016) to compare SRCC with urothelial carcinoma (UC) and investigated the prognostic values of the clinicopathological characteristics and survival outcomes in SRCC of the urinary bladder. Multivariable Cox proportional hazard model, subgroup analyses, and propensity score matching (PSM) were used. Results: In all, 318 patients with SRCC and 57,444 patients with UC were enrolled. Compared with those with UC, patients with SRCC were younger at diagnosis (P < 0.001) and had higher rates of muscle invasive disease (P < 0.001), lymph node metastasis (P < 0.001), and distal metastasis (P < 0.001), as well as higher-grade tumors (P = 0.004). A Cox proportional hazard regression analysis showed that the SRCC group was associated with significantly higher risks of overall mortality (OM) compared with the UC group [hazard ratios (HR) = 1.44, 95% confidence intervals (95% CI) = 1.26-1.63, P < 0.0001]. Patients with SRCC also had a higher risk of cancer-specific mortality (CSM; HR = 1.40, 95% CI = 1.18-1.65, P < 0.0001). After PSM, the SRCC group also experienced higher risks of OM (HR = 1.45, 95% CI = 1.24-1.68, P < 0.0001) and CSM (HR = 1.47, 95% CI = 1.20-1.79, P = 0.0001) compared with the UC group. In the subgroup analyses, no significant interactions were observed in sex, age, N stage, M stage, and lymph nodes removed in terms of both OM and CSM. Conclusion: The prognosis of SRCC is poorer than that of UC, even after adjustment for baseline demographic and clinicopathological characteristic as well as cancer treatment. SRCC is an independent prognostic factor for patients with urinary bladder cancer.

Nomograms to predict individual prognosis of patients with primary signet ring cell carcinoma of the urinary bladder

“…Nomograms are currently one of the most widely used prediction tools, owing to their ability to combine clinical characteristics in generating individual probabilities of clinical events, which could provide clinical decision-making and personalized medical therapy; pure UC and concluded that SRCC was an independent predictor of inferior CSS in contrast to pure UC (16). Similarly, Jin et al reported that compared with pure UC, SRCC was significantly associated with a higher risk of overall and cancer-specific mortality (8). The highly aggressive behaviors and uncertain efficacy of multimodality treatments may result in poor SRCC prognosis.…”

“…Among the BCa types, the major histological type is urothelial carcinoma (UC), while primary signet ring cell carcinoma (SRCC) is rare, accounting for approximately <1% of cases (3,4). Compared with UC, SRCC tends to be associated with worse oncological outcomes, but the prevalent characteristics, treatment options, and prognosis are not comprehensively characterized because of their low occurrence rate (5)(6)(7)(8).…”

“…In this study, we conducted a large-scale, population-based, retrospective, prognostic, and predictive survival analysis; interestingly, we identified several independent features, including T stage, M stage, surgery, tumor size, and LNR, that could affect the oncological outcomes of patients with SRCC. Additionally, we generalized these independent risk factors into two nomograms to predict the prognosis of SRCC, which showed reliable and accurate performance.Recent studies have confirmed that patients with SRCC are more likely to experience a worse prognosis than those with pure UC(6)(7)(8)14,15). Wang et al analyzed the data of 103 patients with SRCC and those of 14,648 patients with…”

Unusual Faces of Bladder Cancer

“…Otherwise, the clinical context of the patient and a basic immunohistochemical panel, for example, CK7/20, GATA-3, CDX-2, and p63, should resolve the dilemma. The analysis of the national Surveillance, Epidemiology, and End Results (SEER) database of 318 such cases confirms the worse prognosis of this histologic variant compared with conventional UC [ 45 ].…”

Prognostic factors and survival outcome of primary pulmonary acinar cell carcinoma

“… 6 In addition, the extensive sample size and statistical validity of the SEER database contribute to the superior value of SEER‐based studies. 7 Similar to those rare diseases, no standardized proposal is available for PACC. Our present knowledge of PACC is mainly derived from case reports or review.…”