Abstract
Tumor deposit (TD) was associated with poor survival in colorectal cancer. However, its prognostic and staging value in locally advanced rectal cancer (LARC) patients following neoadjuvant chemoradiotherapy (neo‐CRT) is controversial. Four hundred and ninety‐five LARC patients following neo‐CRT and surgery were retrospectively analyzed. Univariate and multivariate analyses were performed using Kaplan‐Meier method and Cox proportional hazards regression in all lymph node (LN) ‐negative and LN‐positive patients. Next, we used three methods to classify the counts of LNs and TDs (oN, only LN counts; n1N, counts according to the N1c standards; n2N, total counts of LNs and TDs) to evaluate the impact of TD on N staging. TD‐positive patients were associated with more aggressive clinicopathological features. In multivariate analyses, TD was an independent poor prognostic factor of overall survival (OS), disease‐free survival (DFS), and local recurrence‐free survival in all patients. In LN‐negative patients, TD was an independent poor prognostic factor of OS, DFS and distant metastasis‐free survival (DMFS). In LN‐positive patients, TD has poor prognostic value only in patients with one positive LN. Three multivariate analyses according to three N staging methods showed that oN was not an independent prognostic factor, whereas n1N and n2N were independently associated with poor survival in OS, DFS and DMFS. The n2N method seemed to be better than n1N method. TD is an independent poor prognostic factor in LARC patients following neo‐CRT, especially in patients with no more than one positive LN. TD probably should be considered as one positive LN when performing N staging.
Highlights
Colorectal cancer is the second leading cause of cancer deaths in the United States.[1]
We found that Tumor deposit (TD) was associated with poor overall survival (OS) (HR 2.53, 95% CI 1.43‐4.47, P = 0.001), disease‐free survival (DFS) (HR 2.03, 95% CI 1.29‐3.19, P = 0.002), local recurrence‐free survival (LRFS) (HR 2.77, 95% CI 1.09‐7.03, P = 0.032) and distant metastasis‐free survival (DMFS) (HR 1.81, 95% CI 1.07‐3.07, P = 0.027) in patients with no more than one positive lymph node (LN), independent of other clinicopathological features
In 1997, the fifth edition of the American Joint Committee on Cancer (AJCC) staging manual defined TD according to the criterion of maximum diameter
Summary
Colorectal cancer is the second leading cause of cancer deaths in the United States.[1]. The present study aimed to evaluate the prognostic significance of TDs in LARC patients after neo‐CRT, verify the applicability of the N1c category in those tumors, and explore the appropriate methods of N staging for those patients. (a) oN method, N staging by counting the number of metastatic LNs without TDs. The following three methods were employed (Table S1). (a) oN method, N staging by counting the number of metastatic LNs without TDs It was the old method used before the seventh edition AJCC staging system. (b) n1N method, N staging according to the N1c category of the eighth edition AJCC staging system It is the new method used currently in CRC patients without neo‐CRT. (c) n2N method, N staging by counting the total number of metastatic LNs and TDs, considering one TD as one metastatic LN. All statistical analyses were performed using SPSS version 22.0 (SPSS, Inc., Chicago, IL)
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