Introduction Colon cancer is the third most common cancer worldwide, with signet ring cell carcinoma (SRCC) being a rare subtype accounting for 1-2% of cases. SRCC incidence is increasing among younger patients, and is associated with worse survival rates and poor treatment response compared to other colorectal cancers. This study aims to analyze SRCC’s epidemiology, metastatic patterns, and survival rates, focusing on early-onset cases using the SEER database to provide robust statistical insights.

Methods The study is a retrospective analysis that utilizes a cohort from the Surveillance, Epidemiology, and End Results database from 2000-2020. This study uses several demographic and clinical factors that include age, race, median income, housing, tumor stage, tumor size, lymph node status, metastasis, and treatment modalities (surgery, radiation, chemotherapy).

Results The median age of onset is increasingly earlier, now at 41 years, with most cases occurring between 36-50 years. Common metastasis sites are other locations (38.3%), liver (8.9%), bone (4.2%), and lung (3.8%), with the rectum being the most frequent primary tumor site (29.1%). Predominantly affecting males (62.3%), the cohort includes white (50.6%), Hispanic (21.9%), and African American (12.3%) patients. Surgery with adjuvant chemotherapy is the most common treatment, while chemotherapy-only has the lowest 5-year survival rate (2.6%) and surgery-only the highest (40.2%). Multivariate analysis identifies tumor stage (H.R. 2.15, p <0.001), nodal status (H.R. 3.28, p <0.001), and tumor size (H.R. 2.08, p =0.013) as prognostic factors.

Conclusion

The study indicates a declining median age for young-onset SRCC, which often presents with distant metastasis and advanced-stage due to delayed symptom onset. Worse outcomes are linked to tumor location, nodal status, and size. These findings can guide clinicians in creating personalized treatment plans and risk stratification for SRCC patients.