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Introduction Signet ring cell cancer (SRCC) is a rare and aggressive adenocarcinoma. The incidence of SRCC is rising worldwide. It is often missed during endoscopic examination due to its subtle appearance. SRCC is often widespread at the time of diagnosis making treatment challenging. The aim of this review is to assess the significance of early diagnosis of SRCC and its response to treatment. Methods We collected data from University Hospitals of Leicester for all patients who had histology confirmed diagnosis of SRCC between June 2005 and April 2018. We compared patients who had early SRCC (localized to the primary site), patient who had delayed SRCC (nodal spread) and patients who had late SRCC (distant spread) at the time of diagnosis. We excluded all patients whose staging could not be confirmed. Results 51 patients were diagnosed with SRCC. 3 patients died before staging, hence excluded. 32/48 (66%) were males. Peak incidence age was seen between 70 and 79 years. SRCC was of gastric origin in 19/48 patients (40%), oesophageal in 14/48 patients (29%), colonic in 11/48 patients (23%) and pancreatic in 4/48 patients (8%). 14/48 patients (29%) had early SRCC, 16/48 patients (33%) had delayed SRCC, and 18/48 patients (38%) had late disease at the time of diagnosis. 11/14 (79%) of early SRCC patients and 10/16 (63%) of delayed presentations had surgical resection and neoadjuvant chemotherapy with or without radiotherapy. The rest of the patients were offered palliative therapy. The 2 years survival among early SRCC group was 9/14 (64%), compared to 6/16 (38%) for the delayed SRCC group, and 0/18 (0%) survived in late group. The 2 years survival was 100% in patients treated by surgical resection, neoadjuvant chemotherapy and radiotherapy. Patients with colonic SRCC had the highest mean survival (26.5 months) compared to patients with pancreatic SRCC who had the lowest mean survival (7 months). Conclusions Early diagnosis and effective treatment of SRCC is likely to significantly improve the patient survival. SRCC of colonic origin appears to have the best prognosis. Our data suggest that combined surgical resection and chemo-radiotherapy has the best outcome. However, larger prospective study is likely to help in better understanding of this challenging cancer. |
