Prognostic Analysis of Primary Breast Signet Ring Cell Carcinoma and Mucinous Breast Adenocarcinoma: A SEER Population-Based Study

Survival analysis and establishment of prognostic nomograms for primary breast signet ring cell carcinoma

Primary breast signet ring cell carcinoma (BSRCC) is an extremely rare malignancy with poor prognosis. Few consensus exists regarding the prognostic factors and treatment modalities. This study aimed to develop a nomogram model to predict survival probability and guide clinical treatment for BSRCC patients. Clinicopathological data of BSRCC patients were retrieved from SEER database. Univariate and multivariate Cox regression analyses were performed to screen and identify prognostic factors. Kaplan-Meier method was used to describe the survival curve for each prognostic factor. Additionally, these factors were incorporated to construct nomograms for predicting overall survival (OS) and disease-specific survival (DSS) of BSRCC patients. The nomograms were internally validated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). A total of 362 eligible BSRCC patients were included in this study. Multivariate Cox analysis demonstrated that age at diagnosis, T stage, N stage, and surgery were identified as independent prognostic factors for OS, while grade, T stage, N stage, ER status, and surgery were independent DSS-related factors. Our study elucidated that surgery is the effective treatment for BSRCC, while postoperative radiotherapy does not confer additional benefit to patients. Nomograms were established to predict OS and DSS probability by incorporating independent prognostic factors among BSRCC patients. The nomograms were subsequently validated using ROC curves, calibration curves, and DCA to display the robust prognostic capability. Robust nomograms for OS and DSS of BSRCC patients were established, facilitating precise personalized risk assessment and appropriate treatment regimens in clinical practice.

Clinicopathological features and prognosis of mucinous breast carcinoma with a micropapillary structure

OBJECTIVE

To conduct a comparative analysis of clinicopathological data between mucinous micropapillary breast carcinoma (MUMPC) and pure mucinous carcinoma (PMC) without a micropapillary structure to elucidate the distinctive clinicopathological characteristics of MUMPC and their impact on prognosis.

METHODS

This retrospective analysis included 325 patients diagnosed with mammary mucinous carcinoma admitted to Tianjin Cancer Hospital between July 2014 and December 2019, including 197 patients with MUMPC and 128 patients with PMC without a micropapillary structure. Clinicopathological features were compared, and factors influencing the prognosis of MUMPC were analyzed. Survival analysis was conducted using the Kaplan-Meier method, and univariate and multivariate prognostic analyses for MUMPC were performed using the Cox proportional hazard regression model.

RESULTS

The median follow-up period was 76 months. In the MUMPC and PMC groups, the disease-free survival (DFS) rates at 3, 5, and 7 years were 95.4%, 90.4%, 89.8%, and 100%, 98.4%, and 96.9%, respectively, with a statistically significant difference between the two groups (p = 0.009). Tumor, node, and metastasis (TNM) stage, lymph node metastasis, and endocrine treatment were significant factors influencing the prognosis of the MUMPC group (p < 0.001). Multivariate analysis revealed that lymph node metastasis and endocrine therapy were independent prognostic factors in patients with MUMPC (p < 0.001). Compared with PMC, the MUMPC group exhibited a higher prevalence of HER2 (11.2% vs. 3.1%, p = 0.009) and Ki-67 overexpression (79.7% vs. 60.2%, p < 0.001).

CONCLUSION

The lymph node stage is the most crucial clinicopathological feature of MUMPC. Endocrine treatment strategy is an independent risk factor affecting the prognosis of MUMPC.

Pure signet ring cell carcinoma of the breast: a rare entity

Signet ring cell carcinoma (SRCC) is defined as carcinoma composed of epithelial cells with intracytoplasmic mucin that causes peripheral displacement of the nucleus, creating a crescent-shaped morphology. It can arise in many organs; however, pure primary SRCC of the breast is very rare. The WHO classification of tumours placed SRCC of the breast under mucin-producing carcinomas; however, nowadays, it is no longer regarded as a histological variant of invasive carcinoma. To date, only few cases have been reported in the literature. This report presents a woman in her 70s with primary pure SRCC of the breast. The patient underwent right lumpectomy with sentinel lymph node dissection and was proposed adjuvant chemotherapy followed by radiotherapy and hormonal treatment. She had no disease relapse until today. The histological features and treatment approach of this rare entity are debated in light of relevant literature.

Clinical characteristics, survival and prognostic nomogram for patients with esophageal mucinous adenocarcinoma: a SEER population-based analysis

Background

Esophageal mucinous adenocarcinoma (MAC) is a rare adenocarcinoma (AC) subtype. Limited research exists on its incidence, survival rates, and treatment responses. This study utilized the Surveillance, Epidemiology, and End Results (SEER) database to compare the clinical characteristics and prognoses of patients with esophageal MAC, AC, and signet-ring cell carcinoma (SRC), and developed nomograms to predict outcomes.

Methods

Patient information was retrieved from the SEER database from 2004 to 2015. The baseline characteristics were balanced using propensity score matching (PSM). Prognostic factors for esophageal MAC patients were identified by univariate and multivariate Cox analyses.

Results

A total of 497 esophageal MAC, 21,109 esophageal AC and 1,144 esophageal SRC patients were selected. MAC patients were more likely to have a higher pathological grade (P<0.001), and later T stage (P<0.001) and American Joint Committee on Cancer (AJCC) stage (P=0.003) than AC patients. The proportion of grade I-II MAC patients was higher than that of SRC patients. The overall survival (OS) and cancer-specific survival (CSS) of MAC patients were similar to those of AC patients. However, MAC patients had significantly better OS and CSS than SRC patients. After PSM analysis, the OS and CSS of MAC patients were similar to those of AC and SRC patients (all P>0.05). In MAC patients, N stage, M stage, and surgery were independent predictive factors for both OS and CSS. The area under the curve (AUC) and calibration curves demonstrated high precision and discrimination. Decision curve analysis (DCA) demonstrated that the CSS and OS nomograms have high potential clinical value.

Conclusions

Esophageal MAC patients had similar survival compared with esophageal AC and esophageal SRC patients. The nomograms provide OS and CSS predictions for MAC patients, to aid clinicians in predicting patients' prognoses.

Pure Mucinous Carcinoma of the Breast: Radiologic-Pathologic Correlation

Mucinous carcinoma (MC) of the breast is a rare, specialized subtype of invasive breast carcinoma (IBC) accounting for approximately 1% to 4% of all primary breast malignancies. Mucinous carcinoma occurs predominantly in patients who are postmenopausal or elderly. It is usually detected on screening mammography, but occasionally the patient may present with a palpable mass. The most common mammographic appearance is an equal to high density, oval or round mass with circumscribed or indistinct margins; MC can mimic a benign lesion. Histologically, MC is a well-differentiated cancer characterized by pools of mucin around neoplastic cells. Depending on mucin content, the tumor is classified as pure (≥90% mucin) or mixed (>10% and <90% mucin). Pure MCs (PMCs) are of low or intermediate nuclear grade, and the vast majority are hormone receptor-positive and human epidermal growth factor-2 receptor-negative (luminal A subtype). Pure MCs may be classified as hypocellular (type A) or hypercellular (type B) and have a lower rate of axillary lymph node involvement and more favorable prognosis than IBCs, no special type. The purpose of this article is to review the clinical features, imaging appearances, associated histopathology, and management of PMC.