Prognostic and staging value of tumor deposits in patients with rectal cancer after neoadjuvant chemoradiotherapy.

Abstract

BackgroundThe presence of tumor deposits (TDs) is only considered in the absence of lymph node metastases (LNMs) in the current TNM staging system. However, the prognostic value of TDs when concomitant with LNM for rectal cancer after neoadjuvant chemoradiotherapy (NCRT) remains unclear. This study aimed to evaluate the prognostic value of TDs and when concomitant with LNMs in rectal cancer after NCRT.MethodsPatients with rectal cancer who had received NCRT between 2010 and 2016 were obtained from the Surveillance, Epidemiology and End Results (SEER) 18 (year range, 1975–2016) database. Data were extracted on the following: age, sex, race, TNM stage, total LNs harvested, positive LNs, histologic type, perineural invasion, grade, carcinoma embryonic antigen status, TD number, and cancer-specific survival (CSS) rates. The primary objective was to determine the prognostic impact of TDs on CSS. The effect of the addition of TD to the LNM count for a novel N stage was also evaluated. Univariate and multivariate analyses were performed using the Kaplan-Meier method and Cox models.ResultsOf 9,620 patients, 865 (9.0%) had TDs. TD-positive patients showed a worse prognosis than TD-negative patients (HR =2.39, 95% CI: 2.04–2.80, P<0.001), and multivariate analysis showed that the presence of TDs was an independent poor prognostic factor (HR =1.41, 95% CI: 1.19–1.67, P<0.001). Regarding the LN status, TDs were associated with a higher risk of cancer-specific death in the LNM- group (HR =2.43, 95% CI: 1.86–3.18, P<0.001), M1 group (HR =1.51, 95% CI: 1.08–2.10, P<0.001), and ypN1 group (HR =2.08, 95% CI: 1.61–2.70, P<0.001), but not in the ypN2 group (HR =0.97, 95% CI: 0.69–1.36, P=0.84). Patients with concomitant TDs and LNM showed significantly worse survival than those with TDs or LNM alone (5-year CSS: 48.2%, 72.2%, and 67.8%, respectively). The 5-year CSS rates were 86.2%, 77.4%, 65.1%, 53.8%, and 46.5% for the novel N0, N1a, N1b, N2a, and N2b groups, respectively (P<0.05 across all groups). Time dependent receiver operating characteristic curve analysis and decision curve analysis showed that the novel N stage was superior to the current ypN stage.ConclusionsThe presence of TDs is an independent poor prognostic factor for LARC patients after NCRT. The concomitant presence of TDs and LNM indicates a significantly worse survival, and the addition of TD to LNM may help to better prompt appropriate risk stratification.