Abstract
Background The prognostic value of tumor deposit (TD) count in colorectal cancer (CRC) patients has been rarely evaluated. This study is aimed at exploring the prognostic value of TD count and finding out the optimal cutoff point of TD count to differentiate the prognoses of TD-positive CRC patients. Method Patients diagnosed with CRC from Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010, to December 31, 2012, were analyzed. X-tile program was used to identify the optimal cutoff point of TD count in training cohort, and a validation cohort was used to test this cutoff point after propensity score matching (PSM). Univariate and multivariate Cox proportional hazard models were used to assess the risk factors of survival. Results X-tile plots identified 3 (P < 0.001) as the optimal cutoff point of TD count to divide the patients of training cohort into high and low risk subsets in terms of disease-specific survival (DSS). This cutoff point was validated in validation cohort before and after PSM (P < 0.001, P = 0.002). More TD count, which was defined as more than 3, was validated as an independent risk prognostic factor in univariate and multivariate analysis (P < 0.001). Conclusion More TD count (TD count ≥ 4) was significantly associated with poor disease-specific survival in CRC patients.
Highlights
Colorectal cancer (CRC) is one of the most common malignancies worldwide
After being defined by several editions of American Joint Committee on Cancer (AJCC) staging manual, tumor deposit (TD) was newly defined as isolated tumor foci in the pericolorectal fat or adjacent mesocolic fat away from the leading edge of the tumor without histological evidence of residual lymph node or identifiable vascular or neural structures
It was clear that positive TD status was an independent risk factor of poor prognosis of colorectal cancer (CRC) without metastatic lymph nodes [6], and the classification of N1c has been introduced into AJCC TNM stage system [13]
Summary
Colorectal cancer (CRC) is one of the most common malignancies worldwide. The number of CRC cases ranks third in malignancies worldwide, while the number of deaths caused by CRC ranks second [1, 2]. Since 7th AJCC/TNM staging system, TDs was introduced into N1c category in CRC patients without metastatic lymph nodes, and positive TD status has been shown to be associated with poor outcomes [7, 8]. We used the Surveillance, Epidemiology, and End Results (SEER) Program database to evaluate the prognostic value of TD count for TD-positive CRC patients. X-tile plots identified 3 (P < 0:001) as the optimal cutoff point of TD count to divide the patients of training cohort into high and low risk subsets in terms of disease-specific survival (DSS). This cutoff point was validated in validation cohort before and after PSM (P < 0:001, P = 0:002). More TD count (TD count ≥ 4) was significantly associated with poor disease-specific survival in CRC patients
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