Signet Ring Cell Colorectal and Appendiceal Cancer - A Small Signet Ring Cell Component Is Also Associated with Poor Outcome

Q: What was the study’s main goal regarding signet ring cell (SRC) proportions?

To clarify the clinicopathological relevance of SRC component size, especially for colorectal and appendiceal cancers with SRCs below 50%.

Q: How were patients selected for the analysis?

All patients diagnosed with colorectal or appendiceal cancer in 2009–2020 at Uppsala University Hospital were included from the Swedish Colorectal Cancer Registry.

Q: What outcomes were associated with SRC-containing tumors?

SRC-containing cancers showed aggressive histopathological features, advanced stages, and a strong association with peritoneal metastases, along with poor prognosis even when the SRC component was <50%.

Sep 28, 2026

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Signet ring cell (SRC) carcinoma of colorectal and appendiceal cancer is rare yet characterized by the poorest prognosis, while the impact of an SRC component size below 50% remains unclear. Using patients from the Swedish Colorectal Cancer Registry (2009–2020), this study clinicopathologically analyzed SRC-containing tumors and assessed how SRC component proportion influenced outcomes. SRCs were linked to aggressive features, advanced stages, and particularly peritoneal metastases, with poor survival even when SRCs comprised <50%.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

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Introduction

Abstract

Background

Methods

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cancers Article Signet Ring Cell Colorectal and Appendiceal Cancer: A Small Signet Ring Cell Component Is Also Associated with Poor Outcome Malin Enblad 1, *, P²ter P¡l Egerszegi 2, Helgi Birgisson 1, Tobias Sjöblom 3, Bengt Glimelius 3 and Joakim Folkesson 1 Citation: Enblad, M.; Egerszegi, P.P.; Birgisson, H.; Sjöblom, T.; Glimelius, B.; Folkesson, J. Signet Ring Cell Colorectal and Appendiceal Cancer: A Small Signet Ring Cell Component Is Also Associated with Poor Outcome. Cancers 2023, 15, 2497 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)cancers15092497 Academic Editor: Hidekazu Suzuki Received: 9 March 2023 Revised: 24 April 2023 Accepted: 25 April 2023 Published: 26 April 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Surgical Sciences, Colorectal Surgery, Uppsala University, 751 85 Uppsala, Sweden 2 Department of Immunology, Genetics and Pathology, Clinical Pathology, Uppsala University, 751 08 Uppsala, Sweden 3 Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, 751 85 Uppsala, Sweden * [Correspondence: malin.enblad@surgsci.uu.se](Correspondence: malin.enblad@surgsci.uu.se); Tel.: +46-186171589 Simple Summary: Signet ring cell (SRC) carcinoma of colorectal and appendiceal cancer is rare but is recognized as the histopathological subtype with the poorest prognosis. However, the prognostic relevance of a SRC component <50% is unclear. The aim of this study was to provide a clinicopathological characterization of all SRC-containing colorectal and appendiceal cancers, including those with <50% SRCs. The results showed that SRCs, both 􀀕50% and <50%, were associated with aggressive histopathological features, advanced stages, and, particularly, peritoneal metastases. Information about the presence of SRCs in tumour tissue, not only in the case of 􀀕50% SRCs, should be routinely registered in pathology reports and clinical registers to enable larger studies that can aid our understanding of SRCs in colorectal and appendiceal cancers. Abstract: Background: Colorectal signet ring cell (SRC) carcinoma with 􀀕50% SRCs (SRC 􀀕 50) has a poor prognosis, but the prognostic role of SRCs < 50%(SRC < 50) is unclear. The aim of this study was to provide a clinicopathological characterization of SRC colorectal and appendiceal tumours and analyse the importance of the SRC component size. Methods: All patients in the Swedish Colorectal Cancer Registry diagnosed with colorectal or appendiceal cancer in 2009–2020 at Uppsala University Hospital, Sweden, were included. The SRCs were veriﬁed, and the components estimated by a gastrointestinal pathologist. Results: Of the 2229 colorectal cancers, 51 (2.3%) had SRCs, with a median component size of 30%(interquartile range of 12.5–40) and 10 (0.45%) had SRC 􀀕 50. The SRC tumours were primarily localized in the right colon (59%) and appendix (16%) . No patients with SRCs had stage I disease, and 26 (51%) had stage IV, of whom, 18 (69%) had peritoneal metastases. The SRC tumours were often high grade with perineural and vascular invasion. The 5-year overall survival (OS) rate for patients with SRC 􀀕 50 were 20%(95% conﬁdence interval (CI) 6–70), for SRC < 50, 39%(95% CI 24–61); and for non-SRCs, 55%(95% CI 55–60) . Among the patients with SRC < 50 and <50% extracellular mucin, the 5-year OS was 34%(95% CI 19–61), while those with 􀀕50% extracellular mucin had an OS of 50%(95% CI 25–99). The 5-year recurrence-free survival rates were 51%(95% CI 13–83) for patients with SRC tumours, as compared to 83%(95% CI 77–89) and 81%(95% CI 79–84) for mucinous an

FAQs

What was the study’s main goal regarding signet ring cell (SRC) proportions?

To clarify the clinicopathological relevance of SRC component size, especially for colorectal and appendiceal cancers with SRCs below 50%.

How were patients selected for the analysis?

All patients diagnosed with colorectal or appendiceal cancer in 2009–2020 at Uppsala University Hospital were included from the Swedish Colorectal Cancer Registry.

What outcomes were associated with SRC-containing tumors?

SRC-containing cancers showed aggressive histopathological features, advanced stages, and a strong association with peritoneal metastases, along with poor prognosis even when the SRC component was <50%.

Sep 28, 2026

Uploaded by Rowan