背景:结直肠印戒细胞癌(CSRCC)是一种罕见的临床实体,约占所有结直肠癌的1%。尽管在过去的几十年里已经发表了关于这个特定主题的多项研究,发病机制,相关危险因素,对治疗的潜在影响仍然知之甚少。除了低发病率,历史上混乱的组织学标准导致混乱的数据.然而,CSRCC的发病率上升,以及相对年轻的年龄和相关的预后不良,强调综合有关CSRCC的已知文献的实际兴趣。
目标:为了提供风险因素的最新概述,预后,和CSRCC的管理。
方法:在MEDLINE/PubMed数据库中进行文献检索,使用以下检索词:\'Signet环细胞癌\'和\'结直肠\'。英语学习,1980年1月后出版的,包括在内。定性综合中包括的研究评估了有关流行病学的内容,危险因素,临床,诊断,组织学,和分子特征,以及转移模式和治疗管理。如果可能,提取了所提供的数据,以便对文献进行更详细的概述。
结果:总计,共纳入67篇文献进行定性分析,其中54人符合详细数据提取条件。据报道,CSRCC的发病率在0.1%-2.4%之间,并且在诊断时经常表现为疾病晚期。与粘液性和非特定腺癌相比,CSRCC与总体生存率受损(5年OS:0%-46%)和更差的阶段校正结果相关。建议系统地使用探查性腹腔镜检查来确定腹膜转移的存在。手术是治疗的主要手段,尽管与其他组织学类型相比,CSRCC的治愈性切除率(21%-82%)较低。在腹膜转移的情况下,仅在选定的患者中建议进行细胞减灭术和腹腔热化疗。
结论:CSRCC是一种罕见的临床实体,最常见的特征是年轻和晚期疾病。因此,诊断方式和治疗方法应相应调整。
BACKGROUND: Colorectal signet-ring cell carcinoma (CSRCC) is a rare clinical entity which accounts for approximately 1% of all colorectal cancers. Although multiple studies concerning this specific topic have been published in the past decades, the pathogenesis, associated risk factors, and potential implications on treatment are still poorly understood. Besides the low incidence, historically confusing histological criteria have resulted in confusing data. Nevertheless, the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis, highlight the actual interest to synthesize the known literature regarding CSRCC.
OBJECTIVE: To provide an updated overview of risk factors, prognosis, and management of CSRCC.
METHODS: A literature search in the MEDLINE/PubMed database was conducted with the following search terms used: \'Signet ring cell carcinoma\' and \'colorectal\'. Studies in English language, published after January 1980, were included. Studies included in the qualitative synthesis were evaluated for content concerning epidemiology, risk factors, and clinical, diagnostic, histological, and molecular features, as well as metastatic pattern and therapeutic management. If possible, presented data was extracted in order to present a more detailed overview of the literature.
RESULTS: In total, 67 articles were included for qualitative analysis, of which 54 were eligible for detailed data extraction. CSRCC has a reported incidence between 0.1%-2.4% and frequently presents with advanced disease stage at the time of diagnosis. CSRCC is associated with an impaired overall survival (5-year OS: 0%-46%) and a worse stage-corrected outcome compared to mucinous and not otherwise specified adenocarcinoma. The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised. Surgery is the mainstay of treatment, although the rates of curative resection in CSRCC (21%-82%) are lower compared to those in other histological types. In case of peritoneal metastasis, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients.
CONCLUSIONS: CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation. As such, diagnostic modalities and therapeutic approach should be tailored accordingly.