Clinical significance of signet-ring cells in colorectal mucinous adenocarcinoma
Clinical significance of signet-ring cells in colorectal mucinous adenocarcinoma
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DOI：
10.1038/modpathol.2008.170
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发表时间：
2008-12-01
期刊：
影响因子：
7.5
通讯作者：
Park, Cheol-Keun
中科院分区：
文献类型：
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作者：
Sung, Chang Okh;Seo, Jin Won;Park, Cheol-Keun
结直肠粘液腺癌中粘液偶尔在细胞内积聚，导致印戒细胞形态。在目前的病理学实践中，对于如何报告结直肠粘液腺癌中印戒细胞的次要成分没有明确的规定。我们推测印戒细胞成分的缺失可能对粘液腺癌患者的生存有有利的影响。为了评估结直肠粘液腺癌的生物学特性，我们分析了其临床病理特征、微卫星不稳定性状态和生存结局，并与结直肠印戒细胞癌进行了比较。共纳入266例连续结直肠粘液腺癌患者和65例印戒细胞癌患者。与印戒细胞癌相比，粘液腺癌的特点是发病年龄较大，血管浸润和淋巴结转移较少，TNM分期较低。95例粘液腺癌中21例（22%）和63例印戒细胞癌中12例（19%）为高频微卫星不稳定性。粘液腺癌患者的生存率明显高于印戒细胞癌患者（P <0.0001）或印戒细胞癌患者（按体积计，细胞外粘液含量为450%）（P <0.0001）。在单因素分析中，缺乏印戒细胞成分（P = 0.0197），没有血管浸润，浸润深度减少，没有淋巴结转移，TNM分期较低的粘液腺癌患者的生存有良好的影响。无血管侵犯、无淋巴结转移和较低的TNM分期对印戒细胞癌患者的生存有有利的影响。多因素分析显示，较高的TNM分期和T4期是粘液腺癌患者预后不良的独立预测因素。我们的观察强烈建议病理学家应报告结直肠粘液腺癌中印戒细胞成分的百分比，并且粘液腺癌与印戒细胞癌相比具有不同的生物学行为。
Mucin occasionally accumulates intracellularly in colorectal mucinous adenocarcinomas, resulting in signet-ring cell morphology. In the current practice of pathology, there is no definitive rule on how to report a minor component of signet-ring cells in colorectal mucinous adenocarcinomas. We hypothesized that the absence of signet-ring cell component might have a favorable effect on survival of mucinous adenocarcinoma patients. To assess the biological characteristics of colorectal mucinous adenocarcinoma, we analyzed its clinicopathological features, microsatellite instability status, and survival outcomes and compared them with those of colorectal signet-ring cell carcinoma. A total of 266 consecutive colorectal mucinous adenocarcinoma patients and 65 signet-ring cell carcinoma patients were included. Mucinous adenocarcinomas, by comparison with signet-ring cell carcinomas, were characterized by development at an older age, less frequent vascular invasion and lymph node metastasis, and lower TNM stage at presentation. A total of 21 (22%) of 95 mucinous adenocarcinomas and 12 (19%) of 63 signet-ring cell carcinomas were high-frequency microsatellite instability. Patients with mucinous adenocarcinoma had significantly better survival than those with signet-ring cell carcinoma (P < 0.0001) or than those with signet-ring cell carcinoma showing 450% extracellular mucin by volume (P < 0.0001). In univariate analysis, absence of signet-ring cell component (P = 0.0197), absence of vascular invasion, decreased invasion depth, no lymph node metastasis, and lower TNM stage had a favorable effect on survival of mucinous adenocarcinoma patients. Absence of vascular invasion, no lymph node metastasis, and lower TNM stage had a favorable effect on survival of signet-ring cell carcinoma patients. Multivariate analysis showed that higher TNM stage and T stage 4 were independent predictors of poor outcome in patients with mucinous adenocarcinoma. Our observations strongly suggest that pathologists should report the percentage of signet-ring cell component in colorectal mucinous adenocarcinomas and mucinous adenocarcinoma has different biologic behavior compared with signet-ring cell carcinoma.