ObjectiveTo investigate influence factor of long-term survival of primary colorectal signet-ring cell carcinoma. MethodThe clinical data of 37 patients with primary colorectal signet-ring cell carcinoma from January 1990 to November 2010 in this hospital were analyzed retrospectively. ResultsThe cumulative survival rates of 1-, 2-, 3and 5-year after the initial surgery were 70.3%, 51.4%, 27.0%, and 10.8% respectively. The survival time of 37 patients was 26 months. The results of univariate analysis showed that the TNM stage, T stage, preoperative intestinal obstruction or not, operation mode, and postoperative chemotherapy or not were associated with the survival time of primary colorectal signet-ring cell carcinoma (P < 0.05). The results of multivariable analysis showed that TNM stage, T stage, and preoperative intestinal obstruction or not were the independent factors for the prognosis of patients with primary colorectal signetring cell carcinoma. ConclusionsThe survival rate of patients with primary colorectal signet-ring cell carcinoma is lower. TNM stage, T stage, and preoperative intestinal obstruction or not are independent factors of it. Chemotherapy after operation could prolong survival time of patients with primary colorectal signet-ring cell carcinoma.
ObjectiveTo investigate the clinical, radiological and pathological features of pulmonary lymphangitic carcinomatosis (PLC) from gastric signet ring cell carcinoma.MethodsThe data of 3 cases of PLC from gastric signet ring cell carcinoma were analyzed and relevant literature was reviewed. The electronic databases of Wanfang, VIP, CNKI and PubMed were searched by using the keywords " pulmonary lymphangitic carcinomatosis” and " gastric signet ring cell carcinoma”.ResultsThe average age of three patients was 34 years (ranging from 20 to 50 years). There were 2 males and 1 female. The three patients presented with non-specific respiratory complaints of cough and shortness of breath. Thickening of interlobular septa was the major radiographical abnormality. Mediastinal lymphadenopathy was seen in 1 patient. Bilateral pleural effusion was seen in 2 patients. However, gastroscopy revealed metastatic gastric signet ring cell carcinoma with the presence of lymphagitic carcinomatosis. One patient survived more than seven months with systemic chemotherapy began on day 7 of hospitalization based on the follow-up information available. Literature review found 2 cases of PLC from gastric signet ring cell carcinoma. Two cases were female aged 45 and 59 years. The chief complaints were dry cough and shortness of breath. The survival time was less than 1 month from diagnosis.ConclusionsPLC from gastric signet ring cell carcinoma is easily misdiagnosed as primary pulmonary diseases. Early identification, diagnosis and treatment are crucial to improve the survival of PLC patients.
Objective To summarize the current research advances of colorectal signet-ring cell carcinoma (SRCC). Methods In this paper, the related literatures of colorectal SRCC in recent years were collected and reviewed. Results Colorectal SRCC was a pathological subtype of colorectal adenocarcinoma, with extremely low incidence but high malignancy and poor prognosis. At present, its molecular mechanism was still not very clear and the clinicopathological manifestations were not specific. Surgical treatment was the major treatmen. Conclusions Although we already have a certain degree of understanding about colorectal SRCC, due to the limitations in the results of some related researches because of the small sample size or the single-center study, we still need more researches to improve the cognition of colorectal SRCC.
ObjectiveTo investigate the risk factors of lymph node metastasis for early distal gastric signet ring cell cancer and indications of radical surgery.MethodsFrom Mar. 2013 to Nov. 2018, a total of 91 early gastric cancer patients who accepted radical gestrectomy and regional lymph node dissection, and proved postoperatively for early distal gastric signet ring cell cancer in the First Affiliated Hospital of Soochow University were enrolled in this study. We collected clinicpathologic characteristics, such as gender, age, maximum diameter of tumor, number of lesions, depth of invasion, macroscopic type, and lymphovascular invasion, to explore the risk factors of lymph node metastasis and further analyze the indication of radical surgery.ResultsAll 91 patients accepted radical gestrectomy and regional lymph node dissection, 10 patients suffered from lymph node metastasis. Univariate analysis showed a positive relationship between maximum diameter of tumor (χ2=5.631, P=0.025), depth of invasion (χ2=4.389, P=0.016), number of lesions (χ2=5.615, P=0.023), and lymphovascular invasion (χ2=22.500, P=0.001) and lymph node metastasis of early distal gastric signet ring cell cancer. The multivariate analysis revealed that maximum diameter of tumor (OR=3.675, P=0.012), depth of invasion (OR=3.886, P=0.015), and lymphovascular invasion (OR=8.711, P<0.001) were independent risk factors of lymph node metastasis.ConclusionsThe risk of lymph node metastasis of early distal gastric signet ring cell cancer was high in those with tumor diameter≥2 cm, submucosal cancer, and lymphovascular invasion. Radical surgery might be necessary in cases of early distal gastric signet ring cell cancer that satisfying one of the following criteria: tumor diameter≥2 cm and lymphovascular invasion.
Objective To summarize the pathological, clinical features and research progress of CT diagnosis of signet ring cell carcinoma of the stomach, in order to help further understanding and early clinical diagnosis and treatment of this disease. Method The literatures related to pathological classification, clinical manifestations, metastasis patterns, prognosis and CT features of gastric signet ring cell carcinoma were searched and reviewed. Results Gastric signet ring cell carcinoma often had no special clinical symptoms and signs in the early stage, and often entered the advanced stage when symptoms such as gastric ulcer appeared. Gastric signet ring cell carcinoma is more prone to peritoneal and ascites metastases than other types of gastric cancer. The more specific metastases include diffuse infiltration along the bile duct and portal vein to the hepatic hilar area and extension to the Glisson sheath. Compared with other types of gastric cancer, there is no prognostic advantage. even worse. CT showed that the lesions were mostly located in the middle and lower 1/3 of the stomach, with a diffuse infiltrating gross appearance, obvious thickening and enhancement of the gastric wall, and delayed enhancement, especially in the low-enhanced area. The emerging dual-energy/spectral CT has shown good application prospects for the diagnosis of gastric cancer. Conclusions The pathological clinical features and CT diagnosis of gastric signet ring cell carcinoma have certain characteristics, but there are still many controversies, which are related to the fact that some pathological characteristics or infiltration patterns of gastric signet ring cell carcinoma itself have not been clearly studied, which will be discussed in the future direction of continuing research.
ObjectiveTo investigate the impact of surgical treatment on the prognosis of patients with gastric signet-ring cell carcinoma (GSRC). MethodsThe clinicopathologic and prognosis data of patients pathologically diagnosed with GSRC from 2000 to 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards regression model was used to analyze the impact of surgery on overall survival (OS) and cancer-specific survival (CSS) of patients with GSRC. ResultsA total of 3 457 patients with GSRC were included, including 2 048 cases in the operation group and 1 409 cases in the non-operation group. The propensity-score matching by a 1∶1 nearest neighbour algorithm was conducted to control for confounding baseline differences. There were 802 cases in the operation group and 802 cases in the non-operation group after matching. The OS and CSS curves drawn by Kaplan-Meier method of the operation group were better than those of the non-operation group (χ2=434.3 P<0.001; χ2=412.4, P<0.001). The multivariate Cox proportional hazards regression analysis showed that the elderly (≥ 60 years old), late AJCC tumor stage (stage Ⅰ as reference), and patients with bone metastasis of GSRC increased the risk of shortening OS and CSS (P<0.05), while patients treated with surgery and chemotherapy decreased the risk of shortening OS and CSS (P<0.05). ConclusionAccording to the analysis results of SEER database in this study, surgical treatment is beneficial to improve the prognosis for patients with GSRC.
ObjectiveTo establish and validate a predictive nomogram for predicting the risk of distant metastasis in colorectal signet-ring cell carcinoma based on the Surveillance, Epidemiology, and End Results (SEER) database. MethodsA retrospective analysis was conducted on clinical and pathological data of patients diagnosed with colorectal signet-ring cell carcinoma in the SEER database from 2004 to 2015, and they were randomly divided into training and validation sets at a ratio of 7∶3. Independent risk factors for distant metastasis (DM) in colorectal signet-ring cell carcinoma were screened out in the training set through univariate and multivariate logistic regression analysis, and a nomogram was constructed. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, calibration, and clinical utility of the nomogram model. ResultsA total of 2 595 patients with colorectal signet-ring cell carcinoma were included, of whom 1 022 (39.4%) had DM. According to the univariate and multivariate logistic regression analysis, gender, age, T stage, N stage, surgical treatment, radiotherapy and chemotherapy were independent risk factors for DM of colorectal signet-ring cell carcinoma (P<0.05). Based on the above independent risk factors, a nomogram for DM of colorectal signet-ring cell carcinoma was constructed. The nomogram AUC of the ROC was 0.78 [ 95%CI (0.76, 0.80) ] and 0.77 [ 95%CI (0.74,0.81) ] in the training and validation sets, respectively. The calibration curves showed a good fit in the training and validation sets, with the Hosmer-Lemeshow test results being χ2=9.43, P=0.31 and χ2=12.47, P=0.13, respectively. The DCA curves showed that the model had a net benefit when the threshold probabilities of the training and validation sets were in the range of 10%–95% and 11%–990%, respectively. ConclusionThe nomogram constructed in this study exhibits higher accuracy and reliability, and can be used for early intervention and risk prediction of DM in colorectal signet-ring cell carcinoma.