title: A minor (<50%) signet-ring cell component associated with poor prognosis in colorectal cancer patients: a 26-year retrospective study in China.
abstract: BACKGROUND
  We performed a retrospective study to determine the cancer-specific survival of colorectal cancer patients with a component of signet-ring cells or mucin comprising < 50% of the tumor mass.
  
  
  METHODS
  A total of 2454 patients seen in our hospital from 1985 to 2011 were retrospectively studied. The patients were divided into five groups according to type of cancer: signet-ring cell carcinoma (with > 50% signet-ring cell, n = 36), partial signet-ring cell carcinoma (with < 50% signet-ring cell, n = 28), mucinous adenocarcinoma (with > 50% mucin lacking signet-ring cell, n = 267), partial mucinous adenocarcinoma (with < 50% mucin lacking signet-ring cell, n = 145), and classic adenocarcinoma (with absence of either mucin or signet-ring cell, n = 1978).
  
  
  RESULTS
  Patients with > 50% or < 50% signet-ring cell had the lowest 5-year survival rates (35.5% and 29.7%, respectively), followed by patients with > 50% mucin (48.8%). Patients who had partial mucinous adenocarcinoma with < 50% mucin and classic adenocarcinoma patients had the highest 5-year survival rates (64.8% and 65.3%, respectively). Stratified and multivariate analysis showed that signet-ring cell carcinoma, partial signet-ring cell carcinoma and mucinous adenocarcinoma were independent predictors of decreased survival (hazard ratio 1.699, P = 0.016; hazard ratio 2.182, P = 0.005; hazard ratio 1.532, P < 0.001; respectively), and partial mucinous adenocarcinoma was not (hazard ratio 1.137, P = 0.431).
  
  
  CONCLUSIONS
  Patients with a component of signet-ring cells, regardless of the extent, had poor prognoses. Patients with mucinous adenocarcinoma containing >50% mucin had poor prognoses as well, whereas those with < 50% mucin had survival rates similar to those of classic adenocarcinoma patients. Therefore, in clinical practice, patients with a component of signet-ring cells, regardless of the extent, should be given significant clinical attention.
authors: Dept. of Medical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Yinuo
authors: Y
authors: Tan
authors: Dept. of Oncology, Jinhua Central Hospital, Jinhua, P.R. China.
authors: Jianfei
authors: J
authors: Fu
authors: Dept. of Medical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Xiaofen
authors: X
authors: Li
authors: Dept. of Medical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Jiao
authors: J
authors: Yang
authors: Dept. of Medical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Mengjie
authors: M
authors: Jiang
authors: Dept. of Surgical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China; Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Hangzhou, Zhejiang Province, China, and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Kefeng
authors: K
authors: Ding
authors: Dept. of Pathology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Jinghong
authors: J
authors: Xu
authors: Dept. of Surgical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Jun
authors: J
authors: Li
authors: Dept. of Medical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China; Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Hangzhou, Zhejiang Province, China, and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors: Ying
authors: Y
authors: Yuan
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D002681:China; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D009077:Mucins