Abstract
Globally, gastrointestinal cancer is the most widespread neoplastic disease and the primary contributor to cancer-associated fatalities. Gastrointestinal signet ring cell carcinoma (SRCC) exhibits unique distinguishing features in several aspects when compared to adenocarcinomas (ACs). The scarcity of signet ring cell carcinoma has resulted in a heightened significance of related clinical and molecular investigations. However, a comprehensive and systematic review of the clinical, molecular, therapeutic, and research aspects of this disease is currently absent. This review provides an overview of the latest developments in our understanding of the clinical and molecular features of gastrointestinal signet ring cell carcinoma (SRCC). Additionally, we have compiled a list of potential therapeutic targets or biomarkers, as well as an examination of the current treatment options and the possible mechanisms of formation.
Similar content being viewed by others
Data Availability
All data generated or analysed during this study are included in this published article.
Abbreviations
- SRCC:
-
Signet ring cell adenocarcinomas
- CMT:
-
Combined modality therapy
- GC:
-
Gastric cancer
- CRC:
-
Colorectal cancer
- AC:
-
Conventional adenocarcinoma
- MAC:
-
Mucinous adenocarcinoma
- G-SRCC:
-
Gastric SRC carcinoma
- IGCA:
-
International Gastric Cancer Association
- PC:
-
Poorly cohesive
- WMD:
-
Well-to-moderately differentiated
- NSRCC:
-
Non-SRC
- CRC:
-
Colorectal cancer
- CR-SRCC:
-
Signet ring cell colorectal cancer
- ctDNA:
-
Circular tumour DNA
- MRD:
-
Molecular residual disease
References
Laufman H, Saphir O (1951) Primary linitis plastica type of carcinoma of the colon. AMA Arch Surg 62:79–91. https://doi.org/10.1001/archsurg.1951.01250030082009
Saphir O (1955) Signet-ring cell carcinoma of the urinary bladder. Am J Pathol 31:223–231
Nagtegaal ID, Odze RD, Klimstra D et al (2020) The 2019 WHO classification of tumours of the digestive system. Histopathology 76:182–188. https://doi.org/10.1111/his.13975
Benesch MGK, Mathieson A (2020) Epidemiology of Signet Ring Cell Adenocarcinomas. Cancers (Basel) 12. https://doi.org/10.3390/cancers12061544
Shi T, Song X, Liu Q et al (2019) Survival benefit of palliative gastrectomy followed by chemotherapy in stage IV gastric signet ring cell carcinoma patients: a large population-based study. Cancer Med 8:6010–6020. https://doi.org/10.1002/cam4.2521
Leopoldo S, Lorena B, Cinzia A et al (2008) Two subtypes of mucinous adenocarcinoma of the colorectum: clinicopathological and genetic features. Ann Surg Oncol 15:1429–1439. https://doi.org/10.1245/s10434-007-9757-1
Börger ME, Gosens MJ, Jeuken JW et al (2007) Signet ring cell differentiation in mucinous colorectal carcinoma. J Pathol 212:278–286. https://doi.org/10.1002/path.2181
Nitsche U, Zimmermann A, Späth C et al (2013) Mucinous and signet-ring cell colorectal cancers differ from classical adenocarcinomas in Tumor biology and prognosis. Ann Surg 258 775 – 82; discussion 782-3. https://doi.org/10.1097/SLA.0b013e3182a69f7e
Enlow JM, Denlinger CE, Stroud MR et al (2013) Adenocarcinoma of the esophagus with signet ring cell features portends a poor prognosis. Ann Thorac Surg 96:1927–1932. https://doi.org/10.1016/j.athoracsur.2013.06.047
Wang T, Shen B, Wang L, Liu F (2020) Primary signet ring cell carcinoma of the breast: a rare entity with unique biological behavior-A clinical study based on pure signet ring cell carcinoma cohort. Pathol Res Pract 216:152948. https://doi.org/10.1016/j.prp.2020.152948
Taghavi S, Jayarajan SN, Davey A, Willis AI (2012) Prognostic significance of signet ring gastric cancer. J Clin Oncol 30:3493–3498. https://doi.org/10.1200/JCO.2012.42.6635
Zhao B, Lu H, Luo R et al (2021) Different clinicopathologic features and prognostic significance of signet ring cell histology in early and locally advanced gastric cancer patients. Clin Res Hepatol Gastroenterol 45:101454. https://doi.org/10.1016/j.clinre.2020.05.006
Kwon KJ, Shim KN, Song EM et al (2014) Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach. Gastric Cancer 17:43–53. https://doi.org/10.1007/s10120-013-0234-1
Pernot S, Voron T, Perkins G et al (2015) Signet-ring cell carcinoma of the stomach: impact on prognosis and specific therapeutic challenge. World J Gastroenterol 21:11428–11438. https://doi.org/10.3748/wjg.v21.i40.11428
Chew MH, Yeo SA, Ng ZP et al (2010) Critical analysis of mucin and signet ring cell as prognostic factors in an Asian population of 2,764 sporadic colorectal cancers. Int J Colorectal Dis 25:1221–1229. https://doi.org/10.1007/s00384-010-1033-3
Hyngstrom JR, Hu CY, Xing Y et al (2012) Clinicopathology and outcomes for mucinous and signet ring colorectal adenocarcinoma: analysis from the National Cancer Data Base. Ann Surg Oncol 19:2814–2821. https://doi.org/10.1245/s10434-012-2321-7
Li C, Zheng H, Jia H et al (2019) Prognosis of three histological subtypes of colorectal adenocarcinoma: a retrospective analysis of 8005 Chinese patients. Cancer Med 8:3411–3419. https://doi.org/10.1002/cam4.2234
Luo C, Cen S, Ding G, Wu W (2019) Mucinous colorectal adenocarcinoma: clinical pathology and treatment options. Cancer Commun (Lond) 39:13. https://doi.org/10.1186/s40880-019-0361-0
Fan Y, Bai B, Liang Y et al (2021) Proteomic profiling of gastric Signet Ring Cell Carcinoma tissues reveals characteristic changes of the complement Cascade Pathway. Mol Cell Proteomics 20:100068. https://doi.org/10.1016/j.mcpro.2021.100068
Kim H, Kim BH, Lee D, Shin E (2019) Genomic alterations in signet ring and mucinous patterned colorectal carcinoma. Pathol Res Pract 215:152566. https://doi.org/10.1016/j.prp.2019.152566
Arai T (2019) Where does signet-ring cell carcinoma come from and where does it go? Gastric Cancer 22:651–652. https://doi.org/10.1007/s10120-019-00960-w
Mariette C, Carneiro F, Grabsch HI et al (2019) Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma. Gastric Cancer 22:1–9. https://doi.org/10.1007/s10120-018-0868-0
Monster JL, Kemp LJS, Gloerich M, van der Post RS (2022) Diffuse gastric cancer: emerging mechanisms of Tumor initiation and progression. Biochim Biophys Acta Rev Cancer 1877:188719. https://doi.org/10.1016/j.bbcan.2022.188719
Chen J, Cai R, Ren G et al (2018) Differences in clinicopathological characteristics and computed tomography findings between signet ring cell carcinoma and nonsignet ring cell carcinoma in early and advanced gastric cancer. Cancer Med 7:1160–1169. https://doi.org/10.1002/cam4.1417
Drubay V, Nuytens F, Renaud F et al (2022) Poorly cohesive cells gastric carcinoma including signet-ring cell cancer: updated review of definition, classification and therapeutic management. World J Gastrointest Oncol 14:1406–1428. https://doi.org/10.4251/wjgo.v14.i8.1406
Bae GE, Kang SH, Kim JS et al (2022) Characterization of poorly cohesive and Signet Ring Cell Carcinomas and Identification of PTPRM as a diagnostic marker. Cancers (Basel) 14. https://doi.org/10.3390/cancers14102502
Chen Y, Zhou Q, Wang H et al (2020) Predicting Peritoneal dissemination of gastric Cancer in the era of Precision Medicine: molecular characterization and biomarkers. Cancers (Basel) 12. https://doi.org/10.3390/cancers12082236
Chen TH, Lin WR, Lee C et al (2018) Prognostic stratification of Advanced Gastric Signet Ring Cell Carcinoma by Clinicopathological factors and GALNT14 genotype. J Cancer 9:3540–3547. https://doi.org/10.7150/jca.26293
Chon HJ, Hyung WJ, Kim C et al (2017) Differential Prognostic implications of gastric Signet Ring Cell Carcinoma: Stage Adjusted Analysis from a single high-volume Center in Asia. Ann Surg 265:946–953. https://doi.org/10.1097/SLA.0000000000001793
Liu X, Cai H, Sheng W et al (2015) Clinicopathological Characteristics and Survival Outcomes of Primary Signet Ring Cell Carcinoma in the stomach: retrospective analysis of single Center Database. PLoS ONE 10:e0144420. https://doi.org/10.1371/journal.pone.0144420
Xu J, Sun Z, Ju H et al (2022) Construction of Novel Prognostic Nomogram for Mucinous and Signet Ring Cell Colorectal Cancer patients with a survival longer than 5 years. Int J Gen Med 15:2549–2573. https://doi.org/10.2147/ijgm.S353523
Korphaisarn K, Morris V, Davis JS et al (2019) Signet ring cell Colorectal cancer: genomic insights into a rare subpopulation of colorectal adenocarcinoma. Br J Cancer 121:505–510. https://doi.org/10.1038/s41416-019-0548-9
Holowatyj AN, Lewis MA, Pannier ST et al (2019) Clinicopathologic and Racial/Ethnic differences of Colorectal Cancer among adolescents and Young adults. Clin Transl Gastroenterol 10:e00059. https://doi.org/10.14309/ctg.0000000000000059
Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660
Siegel RL, Torre LA, Soerjomataram I et al (2019) Global patterns and trends in Colorectal cancer incidence in young adults. Gut 68:2179–2185. https://doi.org/10.1136/gutjnl-2019-319511
Chen JS, Hsieh PS, Hung SY et al (2004) Clinical significance of signet ring cell rectal carcinoma. Int J Colorectal Dis 19:102–107. https://doi.org/10.1007/s00384-003-0515-y
Zhu L, Ling C, Xu T et al (2021) Clinicopathological features and survival of Signet-Ring Cell Carcinoma and Mucinous Adenocarcinoma of Right Colon, left Colon, and Rectum. Pathol Oncol Res 27:1609800. https://doi.org/10.3389/pore.2021.1609800
Yokoyama A, Shi BH, Kawai T et al (2007) Muc4 is required for activation of ErbB2 in signet ring carcinoma cell lines. Biochem Biophys Res Commun 355:200–203. https://doi.org/10.1016/j.bbrc.2007.01.133
Xu Q, Karouji Y, Kobayashi M et al (2003) The PI 3-kinase-Rac-p38 MAP kinase pathway is involved in the formation of signet-ring cell carcinoma. Oncogene 22:5537–5544. https://doi.org/10.1038/sj.onc.1206796
Fukui Y (2014) Mechanisms behind signet ring cell carcinoma formation. Biochem Biophys Res Commun 450:1231–1233. https://doi.org/10.1016/j.bbrc.2014.07.025
Ma YR, Ren Z, Conner MG et al (2017) Reduced E-Cadherin and aberrant β-Catenin expression are Associated with Advanced Disease in Signet-Ring Cell Carcinomas. Appl Immunohistochem Mol Morphol 25:432–438. https://doi.org/10.1097/pai.0000000000000317
Liu J, Xiao Q, Xiao J et al (2022) Wnt/β-catenin signalling: function, biological mechanisms, and therapeutic opportunities. Signal Transduct Target Ther 7:3. https://doi.org/10.1038/s41392-021-00762-6
Togasaki K, Sugimoto S, Ohta Y et al (2021) Wnt signaling shapes the histologic variation in diffuse gastric Cancer. Gastroenterology 160:823–830. https://doi.org/10.1053/j.gastro.2020.10.047
Li Y, Li J, Wang R et al (2020) Frequent RNF43 mutation contributes to moderate activation of wnt signaling in colorectal signet-ring cell carcinoma. Protein Cell 11:292–298. https://doi.org/10.1007/s13238-020-00691-0
Ahadi M, Sokolova A, Brown I et al (2021) The 2019 World Health Organization classification of appendiceal, colorectal and anal canal tumours: an update and critical assessment. Pathology 53:454–461. https://doi.org/10.1016/j.pathol.2020.10.010
Shu Y, Zhang W, Hou Q et al (2018) Prognostic significance of frequent CLDN18-ARHGAP26/6 fusion in gastric signet-ring cell cancer. Nat Commun 9:2447. https://doi.org/10.1038/s41467-018-04907-0
Puccini A, Poorman K, Catalano F et al (2022) Molecular profiling of signet-ring-cell carcinoma (SRCC) from the stomach and colon reveals potential new therapeutic targets. Oncogene 41:3455–3460. https://doi.org/10.1038/s41388-022-02350-6
Jin S, Xu B, Yu L et al (2017) The PD-1, PD-L1 expression and CD3 + T cell infiltration in relation to outcome in advanced gastric signet-ring cell carcinoma, representing a potential biomarker for immunotherapy. Oncotarget 8:38850–38862. https://doi.org/10.18632/oncotarget.16407
Nam JY, Oh BY, Hong HK et al (2018) Molecular characterization of Colorectal Signet-Ring Cell Carcinoma using whole-exome and RNA sequencing. Transl Oncol 11:836–844. https://doi.org/10.1016/j.tranon.2018.04.007
Alvi MA, Loughrey MB, Dunne P et al (2017) Molecular profiling of signet ring cell Colorectal cancer provides a strong rationale for genomic targeted and immune checkpoint inhibitor therapies. Br J Cancer 117:203–209. https://doi.org/10.1038/bjc.2017.168
Roy S, Kanda M, Nomura S et al (2022) Diagnostic efficacy of circular RNAs as noninvasive, liquid biopsy biomarkers for early detection of gastric cancer. Mol Cancer 21:42. https://doi.org/10.1186/s12943-022-01527-7
Patel SG, Karlitz JJ, Yen T et al (2022) The rising tide of early-onset Colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol Hepatol 7:262–274. https://doi.org/10.1016/s2468-1253(21)00426-x
Luo H, Zhao Q, Wei W et al (2020) Circulating Tumor DNA methylation profiles enable early diagnosis, prognosis prediction, and screening for Colorectal cancer. Sci Transl Med 12. https://doi.org/10.1126/scitranslmed.aax7533
Kumar NAN, Jose A, Usman N et al (2022) Signet ring cell cancer of stomach and gastro-esophageal junction: molecular alterations, stage-stratified treatment approaches, and future challenges. Langenbecks Arch Surg 407:87–98. https://doi.org/10.1007/s00423-021-02314-6
Shi T, Huang M, Han D et al (2019) Chemotherapy is associated with increased survival from colorectal signet ring cell carcinoma with distant Metastasis: a Surveillance, Epidemiology, and end results database analysis. Cancer Med 8:1930–1940. https://doi.org/10.1002/cam4.2054
Parikh AR, Van Seventer EE, Siravegna G et al (2021) Minimal residual Disease detection using a plasma-only circulating Tumor DNA assay in patients with Colorectal Cancer. Clin Cancer Res 27:5586–5594. https://doi.org/10.1158/1078-0432.Ccr-21-0410
Acknowledgements
We thank Dr. Wanglong Deng, Dr. Guanghua Lu, Mr. Ran Ding from Jiangsu Simcere Diagnostics for their kind assistance.
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
Author ContributionsConception/design: D.W, WP.H; Provision of study material or patients: QJ.H, Y.T, QQ. D, Q.Z; Collection and/or assembly of data: C.Q, DS.C Data analysis and interpretation: All authors. Manuscript writing: D.W, WP.H Final approval of manuscript: All authors.
Corresponding author
Ethics declarations
Conflicts of interest
The authors have no conflict of interest.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Hong, W., Hu, Q., Tan, Y. et al. Gastrointestinal signet ring cell malignancy: current advancement and future prospects. Invest New Drugs 41, 861–869 (2023). https://doi.org/10.1007/s10637-023-01403-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10637-023-01403-1