title: Clinical characteristics and outcomes of patients with primary signet-ring cell carcinoma of the urinary bladder.
abstract: OBJECTIVE
  The aim of this study was to examine the epidemiology, natural history, treatment pattern and predictors of long-term survival of patients with signet-ring cell carcinoma (SRCC) of the urinary bladder based on the analysis of the national Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  RESULTS
  In total, 230 patients with pathologically confirmed SRCC of the urinary bladder were identified between 1973 and 2004. The mean age was 65 ± 13 years. Overall, 75.7% of the patients had a poorly differentiated or undifferentiated histology grade, 26.5% presented with metastatic disease, 59 (25.7%) underwent transurethral resection for bladder tumor only and 107 (46.5%) had partial or radical cystectomy. The 1-, 3- and 10-year cancer-specific survival rates were 66.8, 40.6 and 25.8%, respectively. Using multivariable Cox proportional hazard model, age (HR 1.024; p = 0.004), stage (distant vs. local, HR 6.2; p < 0.001) and cystectomy (HR 0.53; p = 0.002) were identified as independent predictors for cancer-specific survival.
  
  
  CONCLUSIONS
  Receipt of cystectomy was strongly associated with improved survival in the patients with SRCC of urinary bladder. However, many patients with localized tumors did not receive potentially curative cystectomy. Further studies to address the barriers to the delivery of appropriate care to these patients are warranted.
authors.affiliation: Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA. juewang@unmc.edu
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
authors.forename: Fen Wei
authors.initials: FW
authors.lastname: Wang
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000503:physiopathology* / Q000628:therapy*; D018279:Carcinoma, Signet Ring Cell / Q000503:physiopathology* / Q000628:therapy*; D002454:Cell Differentiation; D015653:Cystectomy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology* / Q000628:therapy*