Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Cancer Med. 2019 Apr;8(4):1508-1520. doi: 10.1002/cam4.2034. Epub 2019 Feb 21.
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.
肿瘤沉积（TD）与结直肠癌患者的生存不良有关。然而，在接受新辅助放化疗（neo-CRT）后的局部进展期直肠癌（LARC）患者中，其预后和分期价值仍存在争议。本研究回顾性分析了 495 例接受 neo-CRT 联合手术治疗的 LARC 患者。所有淋巴结（LN）阴性和 LN 阳性患者均采用 Kaplan-Meier 法和 Cox 比例风险回归进行单因素和多因素分析。接下来，我们使用三种方法对 LN 和 TD 的计数进行分类（oN，仅 LN 计数；n1N，根据 N1c 标准计数；n2N，LN 和 TD 的总数），以评估 TD 对 N 分期的影响。TD 阳性患者具有更具侵袭性的临床病理特征。多因素分析显示，TD 是所有患者总生存（OS）、无病生存（DFS）和局部无复发生存（LRFS）的独立不良预后因素。在 LN 阴性患者中，TD 是 OS、DFS 和无远处转移生存（DMFS）的独立不良预后因素。在 LN 阳性患者中，TD 仅在 1 枚阳性 LN 患者中具有不良预后价值。根据三种 N 分期方法进行的三项多因素分析显示，oN 不是独立的预后因素，而 n1N 和 n2N 与 OS、DFS 和 DMFS 的不良生存独立相关。n2N 方法似乎优于 n1N 方法。TD 是 neo-CRT 后 LARC 患者的独立不良预后因素，尤其是在无更多阳性 LN 的患者中。在进行 N 分期时，TD 可能应被视为一个阳性 LN。
