Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2016; 8(12): 819-825
Published online Dec 15, 2016. doi: 10.4251/wjgo.v8.i12.819
Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?
Anup Sunil Tamhankar, Parag Ingle, Reena Engineer, Munita Bal, Vikas Ostwal, Avanish Saklani
Anup Sunil Tamhankar, Parag Ingle, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India
Reena Engineer, Department of Radiotherapy, Tata Memorial Centre, Mumbai, Maharashtra 400012, India
Munita Bal, Department of Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India
Vikas Ostwal, Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India
Avanish Saklani, Department of Gastro-Intestinal Surgery, Tata Memorial Centre, Mumbai, Maharashtra 400012, India
Author contributions: All authors contributed to the manuscript.
Institutional review board statement: We hereby declare that the institutional review board has inspected and approved this retrospective study.
Informed consent statement: We hereby declare that waiver of consent has been obtained for this retrospective study from Institutional Review Board due to lack of direct patient contact. Also this study doesn’t disclose the identity or private information of any of the study patients.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Avanish Saklani, MS, FRCS, Associate Professor, Department of Gastro-Intestinal Surgery, Tata Memorial Centre, Mumbai, Maharashtra 400012, India. asaklani@hotmail.com
Telephone: +91-996-9506719 Fax: +91-222-4177000
Received: April 2, 2016
Peer-review started: April 7, 2016
First decision: June 6, 2016
Revised: July 11, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: December 15, 2016
Processing time: 248 Days and 0.6 Hours
Abstract
AIM

To elaborate about this peculiar variant from a tertiary cancer center from India.

METHODS

It’s a retrospective study (2011-2014) of all patients diagnosed with signet ring colo-rectal cancer (SRCC). Various clinico-pathological variables were studied.

RESULTS

One hundred and seventy consecutive patients with SRCC were diagnosed (11.4% of all colorectal cancers). Median Age of the cohort was 41 years. Most common location was recto-sigmoid area (54.7%). Majority patients presented in stage III and IV (91.2%). Most of the stage IV patients had isolated peritoneal metastases (86.5%). Colonic tumors had higher incidence of peritoneal metastases (91.8% vs 83.3%) as well as isolated peritoneal recurrences (37.5% vs 16.7%) than rectal primaries. Thirty-seven point five percent of patients recurred after curative surgery. Amongst them 63.63% patients had isolated peritoneal recurrences. Circumferential resection margin (CRM) was involved in 17.9% patients. Median relapse free survival (RFS) and overall survival (OS) of the cohort were 14.9 and 18.13 mo respectively. CRM involvement, colonic primary were associated with poorer RFS and OS.

CONCLUSION

SRCC has predilection for peritoneal dissemination. More aggressive and/or extended chemotherapy schedules as well as prophylactic hyperthermic intra-peritoneal chemotherapy at the time of primary surgery may be attempted in these patients.

Keywords: Colorectal cancer; Signet ring cell carcinoma; Peritoneal metastases; Hyperthermic intra-peritoneal chemotherapy

Core tip: The incidence of Signet Ring Colo-Rectal Cancer appears to be higher in Indian subcontinent than the world literature. It has predilection for peritoneal lining. It affects younger age group. Majority cases present in stage III and IV. Recto-sigmoid region is affected commonly. The most common metastatic site and site of recurrence is peritoneal cavity. Probably it should be treated with a different protocol than the conventional adenocarcinoma with focus on aggressive peritoneal cytoreductions and hyperthermic intra-operative intraperitoneal chemotherapy (HIPEC). Further research is needed to evaluate molecular biology of this variant and utility of prophylactic HIPEC during curative surgery.