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

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.