Metastatic colorectal carcinoma with signet-ring cells: Clinical, histological and molecular description from an Association des Gastro-Entérologues Oncologues (AGEO) French multicenter retrospective cohort

Dig Liver Dis. 2022 Mar;54(3):391-399. doi: 10.1016/j.dld.2021.06.031. Epub 2021 Aug 9.

Abstract

Background: Metastatic signet-ring cell colorectal carcinoma is rare. We analyzed its clinicopathological and molecular features, prognostic factors and chemosensitivity.

Methods: Retrospective study from 2003 to 2017 in 31 French centers, divided into three groups: curative care (G1), chemotherapy alone (G2), and best supportive care (G3).

Results: Tumors were most frequently in the proximal colon (46%), T4 (71%), and poorly differentiated (86%). The predominant metastatic site was peritoneum (69%). Microsatellite instability and BRAF mutation were found in 19% and 9% (mainly right-sided) of patients and RAS mutations in 23%. Median overall survival (mOS) of the patients (n = 204) was 10.1 months (95%CI: 7.9;12.8), 45.1 for G1 (n = 38), 10.9 for G2 (n = 112), and 1.8 months for G3 (n = 54). No difference in mOS was found when comparing tumor locations, percentage of signet-ring cell contingent and microsatellite status. In G1, relapse-free survival was 14 months (95%CI: 6.5-20.9). In G2, median progression-free survival (PFS) was 4.7 months (95%CI: 3.6;5.9]) with first-line treatment. Median PFS was higher with biological agents than without (5.0 vs 3.9 months, p = 0.016).

Conclusions: mSRCC has a poor prognosis with specific location and molecular alterations resulting in low chemosensitivity. Routine microsatellite analysis should be performed because of frequent MSI-high tumors in this population.

Keywords: Colorectal cancer; Metastatic; Molecular; Signet-ring cell.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Carcinoma, Signet Ring Cell / genetics*
  • Carcinoma, Signet Ring Cell / mortality
  • Carcinoma, Signet Ring Cell / pathology*
  • Colon / pathology
  • Colorectal Neoplasms / genetics*
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology*
  • Drug Resistance, Neoplasm / genetics
  • Female
  • France
  • Humans
  • Male
  • Microsatellite Instability
  • Middle Aged
  • Mutation
  • Neoplasm Metastasis / genetics
  • Prognosis
  • Proto-Oncogene Proteins B-raf / genetics
  • Retrospective Studies
  • Survival Rate
  • ras Proteins / genetics

Substances

  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf
  • ras Proteins