The value of adjuvant chemotherapy in stage II/III colorectal signet ring cell carcinoma

Abstract

This study aimed to assess the benefit of postoperative adjuvant chemotherapy in stage II-III colorectal signet ring cell carcinoma (SRCC). Qualified postoperative patients were extracted from Surveillance, Epidemiology, and End Results (SEER) database from 2004 until 2015. We collected 1675 patients in the research, and 936 patients were subjected to adjuvant chemotherapy group. the proportions of married status, male, rectal cancer, grade iii/iV, AJcc stage iii and radiotherapy were higher; While, the rates of white race, ≥ 65 years old and located in cecum-transverse colon were lower in patients of chemotherapy group compared to no chemotherapy group (all P < 0.05). K-M plots revealed significantly better OS of adjuvant chemotherapy group than no chemotherapy group (P < 0.001). Meanwhile, there was no significantly different in CSS between the two groups (P = 0.93). However, after adjusting for confounding factors by multivariable Cox regression analysis, receipt of postoperative chemotherapy was still associated with better cSS and oS (cSS: hazard ratio [HR] = 0.719, 95% CI 0.612-0.844, P < 0.001) ; (OS: HR = 0.618, 95% CI 0.537-0.713, P < 0.001). Patients with stage II/III colorectal SRCC could receive survival benefit from postoperative adjuvant chemotherapy. Colorectal cancer (CRC) ranks the third of cancer-associated death, causing great health burden globally 1. The diverse pathological types of CRC have been uncovered to be having correlation with various clinical parameters and patient survival, with adenocarcinoma being most prevalent type 2,3. Signet-ring cell carcinoma (SRCC) is a relatively rare histological subtype, consisting of 0.1-2.6% of CRC patients 4,5 , defined as the abundant presence of intracellular mucin in over 50% cells according to WHO 6,7. SRCC is considered as a distinct pathological subtype in CRCs. A series of differences among colorectal SRCC, mucinous adenocarcinoma (MC) and non-mucinous adenocarcinoma (NMC) have been consistently reported. To be specific, SRCC has been reported to be associated with younger age at diagnosis, more advanced stage and poorer clinical outcomes than MC and NMC 7-9. In addition, massive lymphatic involvement, higher frequency of multiple metastatic organs and greater risks of peritoneal metastases are more commonly seen in SRCC 9. Because SRCC is relatively rare, there is a lack of consensus on therapeutic guidelines due to the difficulty in conducting large randomized controlled trials 5. At present, surgical intervention is still the optimal option for colorectal SRCC patients. Moreover, the combined application of other therapeutics has been increasing, especially chemotherapy 10. Hugen et al. have assessed the efficacy of adjuvant chemotherapy in colorectal SRCC, who further indicated the benefit of adjuvant chemotherapy in stage III SRCC patients 11. Meanwhile, by analyzing the distinct metastatic patterns of colorectal SRCC toward different sites, Tao et al. have demonstrated better survival of received chemotherapy in metastatic colorectal SR...

Clinicopathologic and prognostic factors of patients with T3/T4 colorectal signet ring cell carcinoma: a population-based study

“…Similarly, Zhuang Z et al analyzed 1675 stage II/III colorectal SRCC patients. They concluded that age < 65, tumor size ≤ 5 cm, AJCC stage II, radiotherapy, and chemotherapy were associated with better CSS in colorectal SRCC patients (Zhao et al 2020 ). Studies have shown that tumor TNM stage was closely related to colorectal tumor prognosis (Mlecnik et al 2023 ; Sun et al 2022 ; Delattre et al 2022 ).…”

Case Report: Intramural colonic signet ring cell carcinoma presenting as intestinal pseudo-obstruction: A case presentation and review of the literature

“…In CRC, MSI-H, or mismatch repair deficient (dMMR), is a well-established prognostic biomarker for better survival in SRCC patients with localized cancer stages, but SRCC is associated with shorter survival compared with other CRC patients ( 8 , 10 ). It was reported that undefined postoperative adjuvant chemotherapy improved survival time in 936 stage II–III patients ( 19 ). The patient in this case underwent routine chemotherapy postoperatively according to a previous report that SRCC benefitted comparably from adjuvant fluorouracil-based chemotherapy compared with AC ( 17 ).…”

Clinicopathological and Molecular Characteristics of Colorectal Signet Ring Cell Carcinoma: A Review

“…found that adjuvant fluorouracil-based chemotherapy for stage III colon cancer yielded similar benefits for the conventional and SRC subtypes. A recent study including 1,675 patients with stage II/III colorectal SRCC showed that postoperative chemotherapy was an independent prognostic factor for better CSS and OS (CSS: HR = 0.719, 95% CI 0.612–0.844, p < 0.001); (OS: HR = 0.618, 95% CI 0.537–0.713, p < 0.001) [ 84 ].…”