A minor (<50%) signet-ring cell component associated with poor prognosis in colorectal cancer patients: a 26-year retrospective study in China

• Published in: PloS one Vol. 10; no. 3; p. e0121944
• Main Authors: Tan, Yinuo, Fu, Jianfei, Li, Xiaofen, Yang, Jiao, Jiang, Mengjie, Ding, Kefeng, Xu, Jinghong, Li, Jun, Yuan, Ying
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.03.2015; Public Library of Science (PLoS)
• Subjects: Adenocarcinoma; Adenocarcinoma - diagnosis; Adenocarcinoma - metabolism; Adenocarcinoma - pathology; Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Cancer; Cancer research; Carcinoma, Signet Ring Cell - diagnosis; Carcinoma, Signet Ring Cell - metabolism; Carcinoma, Signet Ring Cell - pathology; Cell survival; Chemotherapy; China; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - metabolism; Colorectal Neoplasms - pathology; Disease prevention; Female; Gastroenterology; Health hazards; Histology; Hospitals; Humans; Laboratories; Male; Medical prognosis; Medicine; Metastasis; Middle Aged; Molecular biology; Mucin; Mucins - metabolism; Multivariate analysis; Oncology; Ostomy; Pathology; Patients; Prognosis; Recurrence; Retrospective Studies; Studies; Survival; Survival Analysis; Tumors; Young Adult; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0121944

We performed a retrospective study to determine the cancer-specific survival of colorectal cancer patients with a component of signet-ring cells or mucin comprising < 50% of the tumor mass. A total of 2454 patients seen in our hospital from 1985 to 2011 were retrospectively studied. The patients were divided into five groups according to type of cancer: signet-ring cell carcinoma (with > 50% signet-ring cell, n = 36), partial signet-ring cell carcinoma (with < 50% signet-ring cell, n = 28), mucinous adenocarcinoma (with > 50% mucin lacking signet-ring cell, n = 267), partial mucinous adenocarcinoma (with < 50% mucin lacking signet-ring cell, n = 145), and classic adenocarcinoma (with absence of either mucin or signet-ring cell, n = 1978). Patients with > 50% or < 50% signet-ring cell had the lowest 5-year survival rates (35.5% and 29.7%, respectively), followed by patients with > 50% mucin (48.8%). Patients who had partial mucinous adenocarcinoma with < 50% mucin and classic adenocarcinoma patients had the highest 5-year survival rates (64.8% and 65.3%, respectively). Stratified and multivariate analysis showed that signet-ring cell carcinoma, partial signet-ring cell carcinoma and mucinous adenocarcinoma were independent predictors of decreased survival (hazard ratio 1.699, P = 0.016; hazard ratio 2.182, P = 0.005; hazard ratio 1.532, P < 0.001; respectively), and partial mucinous adenocarcinoma was not (hazard ratio 1.137, P = 0.431). Patients with a component of signet-ring cells, regardless of the extent, had poor prognoses. Patients with mucinous adenocarcinoma containing >50% mucin had poor prognoses as well, whereas those with < 50% mucin had survival rates similar to those of classic adenocarcinoma patients. Therefore, in clinical practice, patients with a component of signet-ring cells, regardless of the extent, should be given significant clinical attention.