Peparini Nadia
Azienda Sanitaria Locale Roma 6- Distretto 3, via Mario Calò, 5- 00043, Ciampino, Rome, Italy.
Surg Oncol. 2018 Jun;27(2):129-137. doi: 10.1016/j.suronc.2018.02.007. Epub 2018 Feb 21.
This review aims to describe the results of the most recent studies on the prognostic value of TDs and highlight the impact of TDs on the staging and treatment of colorectal and gastric carcinoma. For colorectal carcinoma TDs have an adverse prognostic effect that is at least similar to that of positive regional lymph nodes. However, support is growing in favor of including of TDs in the M category, rather than the N or T categories of the TNM classification. Moreover, TDs seem to have an adverse effect on outcomes not only in patients without lymph node involvement but also in patients with nodal involvement. Although the prognostic impact of TDs in gastric cancer appears to be undeniable, the actual prognostic determinants of TDs, particularly in relation to the number, size and histological types, remain to be established. Although the 7th and 8th Edition of the TNM classification of colorectal and gastric carcinoma includes TDs in the N category, no current procedures or methods to assess preoperative or intraoperative N-status allow TD detection. After neoadjuvant treatment for advanced rectal carcinoma, the presence of TDs may indicate incomplete eradication of the main tumor and not discontinuous tumor foci. TDs have an undeniable prognostic impact but no algorithm of staging and strategy of treatment has been conformed to this prognostic factor to overcome the classical T,N, and M prognostic categories. Staging and treatment of colorectal and gastric cancers should be reconsidered in light of the emerging prognostic value of TDs.
本综述旨在描述关于肿瘤 deposits（TDs）预后价值的最新研究结果，并强调 TDs 对结直肠癌和胃癌分期及治疗的影响。对于结直肠癌，TDs 具有不良预后影响，其至少与阳性区域淋巴结的预后影响相似。然而，越来越多的人支持将 TDs 纳入 TNM 分类的 M 类别，而非 N 或 T 类别。此外，TDs 似乎不仅对无淋巴结转移的患者，而且对有淋巴结转移的患者的预后都有不良影响。尽管 TDs 在胃癌中的预后影响似乎不可否认，但 TDs 的实际预后决定因素，特别是与数量、大小和组织学类型相关的因素，仍有待确定。尽管结直肠癌和胃癌的 TNM 分类第 7 版和第 8 版将 TDs 纳入 N 类别，但目前尚无评估术前或术中 N 状态的程序或方法可检测到 TDs。在晚期直肠癌新辅助治疗后，TDs 的存在可能表明主要肿瘤未完全根除，而非肿瘤灶间断存在。TDs 具有不可否认的预后影响，但尚未有符合这一预后因素的分期算法和治疗策略来克服经典的 T、N 和 M 预后类别。鉴于 TDs 新出现的预后价值，应重新考虑结直肠癌和胃癌的分期及治疗。
