Division of Gastrointestinal Surgical Oncology, Department of Translational Medical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
Division of Pathology, Department of Mental and Physical Health and Rehabilitation Medicine, School of Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy.
J Gastrointest Surg. 2024 Jan;28(1):47-56. doi: 10.1016/j.gassur.2023.11.003.
Tumor deposits (TDs) are emerging as an adverse prognostic factor in colorectal cancers (CRCs). However, TDs are somewhat neglected in the current staging system. It has been proposed either to add the TD count to the number of metastatic lymph nodes or to consider TDs as distant metastases; however, the scientific basis for these proposals seems questionable. This study aimed to investigate a new staging system.
A total of 243 consecutive patients with stage III CRC who were undergoing curative resection and adjuvant chemotherapy were included. Each substage of stage III TNM was split according to the absence or presence of TDs. Receiver operating characteristic (ROC) curves and bootstrap methods were used to compare the current vs the new competing staging system in terms of oncologic outcome prediction.
A high rate of TDs was recorded (124 cases [51%]). TDs were correlated with other adverse prognostic indicators, particularly vascular and perineural invasions, and showed a negative correlation with the number of removed lymph nodes, suggesting a possible multimodal origin. In addition, TDs were confirmed to have a negative impact on oncologic outcome, regardless of their counts. Compared with the current staging system, the new classification displayed higher values at survival ROC analysis, a significantly better stratification of patients, and effective identification of patients at high risk of recurrence.
TDs negatively affect the prognosis in CRCs. A revision of the staging system could be useful to optimize treatments. The proposed new classification is easy to implement and more accurate than the current one. This study was registered online on the ClinicalTrials.gov website under the following identifier: NCT05923450.
肿瘤沉积物（TDs）在结直肠癌（CRC）中是一个新的不良预后因素。然而，TD 在目前的分期系统中有些被忽视。有人提议将 TD 计数添加到转移淋巴结的数量中，或者将 TD 视为远处转移；然而，这些提议的科学依据似乎值得怀疑。本研究旨在探讨一种新的分期系统。
共纳入 243 例接受根治性切除术和辅助化疗的 III 期 CRC 连续患者。根据是否存在 TD，将 III 期 TNM 的每个亚期分为两组。使用接收者操作特征（ROC）曲线和自举法比较当前与新的竞争分期系统在肿瘤学结果预测方面的差异。
记录到 TD 发生率较高（124 例[51%]）。TD 与其他不良预后指标相关，特别是血管和神经周围侵犯，并且与切除的淋巴结数量呈负相关，提示可能存在多模式起源。此外，无论 TD 数量多少，TD 均对肿瘤学结果产生负面影响。与当前的分期系统相比，新的分类在生存 ROC 分析中具有更高的值，患者的分层明显更好，并且能够有效识别高复发风险的患者。
TD 对 CRC 的预后有负面影响。分期系统的修订可能有助于优化治疗。所提出的新分类易于实施，比当前的分类更准确。本研究已在 ClinicalTrials.gov 网站上注册，标识符为 NCT05923450。
