Prognostic impact of tumor deposits on overall survival in colorectal cancer: Based on Surveillance, Epidemiology, and End Results database

Abstract

BACKGROUND In colorectal cancer, tumor deposits (TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases (LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately. AIM To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count. METHODS The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival (OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs. RESULTS Overall, 103755 patients were enrolled with 14131 (13.6%) TD-positive and 89624 (86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3% (95%CI, 46.5%-48.1%) and 77.5% (95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS (hazard ratio, 1.35; 95%CI, 1.31-1.38; P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965 (4.4%) N1 patients were restaged as pN2, with worse outcomes than patients restaged as pN1 (3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively; P < 0.0001). CONCLUSION TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.

Prognostic and predictive value of tumor deposits in advanced signet ring cell colorectal cancer: SEER database analysis and multicenter validation

“…We report for the first time that TD positivity is an independent factor strongly related to the poor prognosis of this rare tumor type. In our study, the overall positive rate of TD in stage III/IV colorectal SRCC ranges between 41.5 and 49.8%, which is significantly higher than that observed in stage III/IV CRC (16.3–27.1%) [ 22 , 23 ]. The 5-year OS of stage III/IV colorectal SRCC in our study was 23.5-27.2%, which was similar to the results of a Korean study [ 24 ] and significantly lower than that of stage III/IV CRC (32.3-80.7%) [ 25 ].…”

A nomogram prediction model based on clinicopathological combined radiological features for metachronous liver metastasis of colorectal cancer

“…In the latest 7 th and 8 th editions of the American Joint Committee on Cancer (AJCC) TNM staging system, if there is a positive tumor deposit but no concurrent LN metastasis, the N stage should be categorized as the N1c stage 32 . Positive tumor deposits are associated with recurrence, metastasis, and poorer survival outcomes in CRC patients [33][34][35] . In the present study, positive tumor deposit was independently associated with the development of MLM by multivariable logistic regression analysis.…”

The development and implementation of pathological parameters and molecular testing impact prognosis of colorectal adenocarcinoma

“…However, if TD is diagnosed as neurovascular invasion, the tumor stage is considered stage II (T3N0) with high-risk factors, and patients may not require treatment but instead require close surveillance. 22 In clinical practice, we gradually realized that the presence of TD is an important prognostic factor for CRC patients at stage III, and adding TD to N staging may help better determine the duration of adjuvant therapy. After discussing during MDT meetings, we included TD information in the pathology report format since 2017.…”