Prognosis and clinical characteristics of signet ring cell colorectal peritoneal metastases – a Swedish population-based study

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-09-02 DOI:10.1016/j.ejso.2025.110429

Malin Enblad , Lana Ghanipour , Gabriella Palmer , Valentinus Valdimarsson , Elinor Bexe Lindskog , Peter Cashin

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引用次数: 0

Abstract

Background

Signet ring cell (SRC) colorectal cancer is strongly associated with peritoneal metastases (PM), but the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains uncertain due to poor prognosis. This study aimed to analyse the prognostic impact of SRCs, assess clinical characteristics, and evaluate the risk of open-close laparotomy.

Methods

This Swedish population-based study included patients with colorectal PM accepted for initial CRS and HIPEC at four national centres between 2010 and 2023. Data were retrieved from the Swedish HIPEC registry. Tumours with ≥50% and <50% SRCs were included.

Results

Among 810 patients, 97 (12%) had SRC tumours. SRC patients had a higher risk of open-close laparotomy (22% vs. 13%, p=0.04) and worse 5-year overall survival (OS) compared to non-SRC patients (18% vs. 32%, p=0.004). SRC patients were younger, more often had synchronous PM, regional lymph node metastases, higher peritoneal cancer index, and were less likely to receive neoadjuvant treatment or have synchronous liver metastases. At diagnosis, PM were more often an unexpected intraoperative finding, and SRC patients exhibited a stronger preoperative systemic inflammatory response, with a higher CRP/albumin ratio. Among those undergoing CRS and HIPEC, the 5-year OS was 24% (95% CI: 14–40) in SRC patients and 36% (95% CI: 32–42, p=0.056) in non-SRC patients.

Conclusion

SRC colorectal PM is associated with a high risk of open-close laparotomy, poor prognosis, and distinct clinical features. These findings highlight the aggressive nature of SRCs but suggest that CRS and HIPEC should not be excluded for these patients.

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印戒细胞结直肠腹膜转移的预后和临床特征-一项基于瑞典人群的研究

背景：signet ring cell （SRC）结直肠癌与腹膜转移（PM）密切相关，但由于预后不良，细胞减缩手术（CRS）和腹腔内高温化疗（HIPEC）的作用仍不确定。本研究旨在分析src对预后的影响，评估临床特征，并评估开腹手术的风险。方法：这项基于瑞典人群的研究纳入了2010年至2023年间在四个国家中心接受初始CRS和HIPEC治疗的结直肠PM患者。数据从瑞典HIPEC注册中心检索。≥50%和<；50% src的肿瘤被纳入研究。结果810例患者中有97例（12%）存在SRC肿瘤。与非SRC患者相比，SRC患者有更高的开腹手术风险（22%对13%，p=0.04）和更差的5年总生存率（OS）（18%对32%，p=0.004）。SRC患者年龄较小，多发生同步PM、局部淋巴结转移，腹膜癌指数较高，接受新辅助治疗或发生同步肝转移的可能性较小。在诊断时，PM更多的是术中意外发现，SRC患者表现出更强的术前全身炎症反应，CRP/白蛋白比值更高。在接受CRS和HIPEC的患者中，SRC患者的5年OS为24% (95% CI: 14-40)，非SRC患者的5年OS为36% （95% CI: 32-42, p=0.056）。结论src型结直肠PM与开腹合拢手术风险高、预后差、临床特点明显相关。这些发现强调了src的侵袭性，但也提示这些患者不应排除CRS和HIPEC。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.