Young-onset signet ring cell colorectal adenocarcinoma: demographics, clinicopathological profile, and survival analysis

Background Signet ring cell carcinoma (SRCC), a rare subtype of colorectal adenocarcinoma, is associated with high rates of metastasis at presentation and poor prognosis. This study highlights demographic patterns, survival outcomes, and prognostic factors in young-onset SRCC.Methods A retrospective analysis of SRCC patients <50 years was conducted using the Surveillance, Epidemiology, and End Results database (2000–2020).Results There was a high prevalence of SRCC in young patients, with a median age at diagnosis of 41.0 years. A significant proportion of cases were in individuals ages 36 to 50. The rectum was the most common primary site (29.1%), and the liver was the most frequent site of metastasis at presentation (8.9% of patients with known metastases). Surgery combined with adjuvant chemotherapy yielded the highest 5-year survival (24.4%; 95% confidence interval [CI], 22.1–26.7), compared with chemotherapy alone (2.6%; 95% CI, 1.2–4.0). Multivariate analysis identified advanced stage, nodal positivity, distant metastases (hazard ratio 7.02; 95% CI, 4.66–10.56), and larger tumor size as significant adverse prognostic factors (all P < 0.001).Conclusions Colorectal SRCC is an aggressive malignancy that disproportionately affects patients <50 years and frequently presents at advanced stages, underscoring the importance of earlier screening.