The prognostic significance of different proportion of signet-ring cells of colorectal carcinoma

While the prognosis of patients with partial signet-ring cell carcinoma (PSRCC) has been rarely reported, colorectal signet-ring cell carcinoma (SRCC) has been associated with poor prognosis. The aim of this study was to analyze the prognosis of patients with different signet-ring cell (SRC) composition and establish a prediction model. A total of 91 patients with SRC component were included in the study. These patients were divided into two groups: SRCC group (SRC composition >50%; n = 41) and PSRCC group (SRC composition <= 50%; n = 50). COX regression model was used to identify independent prognostic factors for overall survival (OS). A predictive nomogram was established and compared with the 7th American Joint Committee on Cancer (AJCC) staging system. After a median follow-up of 16 months, no significant difference in OS was observed in either group. Pre-operative carcinoembryonic antigen level, pN stage, M stage, pre-operative ileus, and adjuvant chemotherapy were independent prognostic risk factors for OS (p < 0.05). A nomogram for predicting the OS of colorectal SRCC was established with a C-index of 0.800, and it showed better performance than that of the 7th AJCC staging system (p < 0.001). In summary, the ratio of SRC component was not an independent prognostic factor of the OS. Those patients with <50% of SRC component should be given the same clinical attention. A predictive nomogram for survival based on five independent prognostic factors was developed and showed better performance than the 7th AJCC staging system. This resulted to be helpful for individualized prognosis prediction and risk assessment.