Clinicopathological characteristics and long-term prognosis of duodenal signet ring cell carcinoma: a SEER-based
Jiayi Ding1, Ye Ye2, Luojie Liu2
1Department of Gastroenterology, Changshu Haiyu Central Health Center, Suzhou, China.
Background:
Signet ring cell carcinoma (SRCC) of the duodenum represents an exceedingly uncommon and highly aggressive variant of duodenal malignancy. Due to its scarcity, the clinicopathological features and long-term prognostic outcomes of duodenal SRCC remain poorly understood. The present study endeavors to analyze these aspects using data from the Surveillance, Epidemiology, and End Results (SEER) database.
Methods:
Patients with duodenal SRCC and adenocarcinoma (AC) diagnosed from 2000 to 2021 were retrieved from the SEER database. Propensity score matching (PSM) approach was used to address confounding factors. The comparison of clinicopathological features was conducted utilizing Chi-squared tests. The evaluation of overall survival (OS) and cancer-specific survival (CSS) was carried out through the application of Kaplan-Meier curves and Cox proportional hazards regression analysis.
Results:
A total of 6,132 patients were collected, including 243 with SRCC and 5,889 with AC. SRCC patients were younger, had poorer grade, higher T stage, and more distant (40.7%) and lymph node (39.1%) metastases than AC patients. Age and T stage were risk factors for lymph node metastasis in duodenal SRCC. The 1-, 3-, 5-, and 10-year OS rates for SRCC patients were 42.1%, 22.9%, 17.6%, and 12.1%, respectively, with corresponding CSS rates of 49.4%, 30.1%, 24.4%, and 20.6%. Multivariate Cox regression analysis identified N stage, M stage, surgery, and chemotherapy as significant predictors of OS and CSS. Compared to the no therapy group, the combination of surgery and chemotherapy was optimal for improving OS [hazard ratio (HR): 0.21, 95% confidence interval (CI): 0.14-0.31, P<0.001] and CSS (HR: 0.22, 95% CI: 0.14-0.35, P<0.001). After 1:1 PSM, 243 patient pairs were analyzed; OS (HR: 0.97, 95% CI: 0.80-1.17, P=0.74) and CSS (HR: 0.91, 95% CI: 0.74-1.13, P=0.40) were comparable between SRCC and AC groups.
Conclusions:
Despite distinct clinicopathological features, duodenal SRCC and AC share similar long-term prognoses. Surgery plus chemotherapy is optimal for improving outcomes in SRCC.
