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01-10-2009 | Gastrointestinal Oncology

Critical Analysis of 33 Patients with Peritoneal Carcinomatosis Secondary to Colorectal and Appendiceal Signet Ring Cell Carcinoma

Authors: Terence C. Chua, BScMed (Hons), Joerg O. W. Pelz, MD, Alexander Kerscher, MD, David L. Morris, MD, Jesus Esquivel, MD

Published in: Annals of Surgical Oncology | Issue 10/2009

Abstract

Background

Primary signet-ring cell carcinoma (SRC) of colorectal and appendiceal origin is a rare entity with an aggressive biology and clinical behavior. The majority of patients develop peritoneal carcinomatosis (PC) early in the disease. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may potentially improve survival.

Methods

An observational study of 33 patients with SRC of colorectal or appendiceal origin was identified through a retrospective review of two peritoneal surface malignancy databases between January 1997 and December 2008. Survival analysis was performed using the Kaplan-Meier method.

Results

Thirty-three patients (18 women (55%); mean age at diagnosis of carcinomatosis, 49 (standard deviation = 12) years) were identified to have SRC, with 15 cases of colorectal and 18 of appendiceal origin. For patients with colonic SRC who underwent complete CRS and HIPEC versus systemic chemotherapy only, the median survival was 13 and 18 months (P = 0.75). For patients with appendiceal SRC who underwent complete CRS and HIPEC versus systemic chemotherapy only, the median survival was 27 and 15 months (P = 0.12).

Conclusions

There seems to be less survival benefits after a complete CRS and HIPEC as a curative treatment for PC from colorectal SRC compared with that for non-SRC colorectal adenocarcinoma. However, in patients with appendiceal SRC, long-term survival is a reality after treatment.

Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, et al. SEER Cancer Statistics Review, 1975-2005, National Cancer Institute. Bethesda, MD. 2008 [updated 2008; cited]. http://seer.cancer.gov/csr/1975_2005/.

Kang H, O’Connell JB, Maggard MA, Sack J, Ko CY. A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum. 2005;48:1161–8.CrossRefPubMed

Pande R, Sunga A, Levea C, Wilding GE, Bshara W, Reid M, et al. Significance of signet-ring cells in patients with colorectal cancer. Dis Colon Rectum. 2008;51:50–5.CrossRefPubMed

Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol. 2007;14:128–33.

Esquivel J, Elias D, Baratti D, Kusamura S, Deraco M. Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol. 2008;98:263–7.CrossRefPubMed

Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21:3737–43.CrossRefPubMed

Jacquet P, Sugarbaker PH. Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res. 1996;15:49–58.

Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221:29–42.PubMed

Ogino S, Brahmandam M, Cantor M, Namgyal C, Kawasaki T, Kirkner G, et al. Distinct molecular features of colorectal carcinoma with signet ring cell component and colorectal carcinoma with mucinous component. Mod Pathol. 2006;19:59–68.CrossRefPubMed

10.

Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.CrossRefPubMed

11.

Bittorf B, Merkel S, Matzel KE, Wein A, Dimmler A, Hohenberger W. Primary signet-ring cell carcinoma of the colorectum. Langenbecks Arch Surg. 2004;389:178–83.CrossRefPubMed

12.

Lee W-S, Chun H-K, Lee WY, Yun SH, Cho YB, Yun H-R, et al. Treatment outcomes in patients with signet ring cell carcinoma of the colorectum. Am J Surg. 2007;194:294–8.CrossRefPubMed

13.

Ooi BS, Ho YH, Eu KW, Seow Choen F. Primary colorectal signet-ring cell carcinoma in Singapore [comment]. A N Z J Surg. 2001;71:703–6.CrossRef

14.

Psathakis D, Schiedeck TH, Krug F, Oevermann E, Kujath P, Bruch HP. Ordinary colorectal adenocarcinoma vs. primary colorectal signet-ring cell carcinoma: study matched for age, gender, grade, and stage. Dis Colon Rectum. 1999;42:1618–25.

15.

Sung CO, Seo JW, Kim K-M, Do I-G, Kim SW, Park C-K. Clinical significance of signet-ring cells in colorectal mucinous adenocarcinoma. Mod Pathol. 2008;21:1533–41.CrossRefPubMed

16.

Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei.” Am J Surg Pathol. 1995;19:1390–408.PubMedCrossRef

17.

Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol. 2003;27:1089–103.CrossRefPubMed

18.

Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7:69–76.CrossRefPubMed

19.

Moran B, Baratti D, Yan TD, Kusamura S, Deraco M. Consensus statement on the loco-regional treatment of appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei). J Surg Oncol. 2008;98:277–82.CrossRefPubMed

Title: Critical Analysis of 33 Patients with Peritoneal Carcinomatosis Secondary to Colorectal and Appendiceal Signet Ring Cell Carcinoma
Authors: Terence C. Chua, BScMed (Hons)
Joerg O. W. Pelz, MD
Alexander Kerscher, MD
David L. Morris, MD
Jesus Esquivel, MD
Publication date: 01-10-2009
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 10/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-009-0536-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Critical Analysis of 33 Patients with Peritoneal Carcinomatosis Secondary to Colorectal and Appendiceal Signet Ring Cell Carcinoma

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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