Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2024 Dec 1;130(23):4052-4060. doi: 10.1002/cncr.35491. Epub 2024 Sep 22.
BACKGROUND: The identification of tumor deposits (TD) currently plays a limited role in staging for colorectal cancer (CRC) aside from N1c lymph node designation. The objective of this study was to determine the prognostic impact, beyond American Joint Committee on Cancer N1c designation, of TDs among patients with primary CRC. METHODS: Patients who had resected stage I-III primary CRC diagnosed between 2010 and 2019 were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Cancer-specific survival (CSS) stratified by TD status and lymph node (N) status was calculated using the Kaplan-Meier method and multivariable Cox proportional hazards regression analyses. RESULTS: In total, 147,783 patients with primary CRC were identified. TDs were present in 15,444 patients (10.5%). The presence of TDs was significantly associated with adverse tumor characteristics, including advanced pathologic stage, nodal status, and metastasis status. The presence of TDs was associated with worse CSS (hazard ratio [HR], 3.12; 95% confidence interval [CI], 3.02-3.22), as it was for each given N category (e.g., N2a and TD-negative [HR, 2.50; 95% CI, 2.37-2.64] vs. N2a and TD-positive [HR, 3.75; 95% CI, 3.49-4.03]). The presence of multiple TDs was also associated with decreased CSS for each given N category compared with a single TD (e.g. N2a with one TD [HR, 3.09; 95% CI, 2.65-3.61] vs. N2a with two or more TDs [HR, 4.32; 95% CI, 3.87-4.82]). CONCLUSIONS: TDs were identified as an independent predictor of a worse outcome in patients with CRC. The presence of TDs confers distinctly different CSS and provides important prognostic information among patients with CRC and warrants further investigation as a unique variable in future iterations of CRC staging.
背景:除了 N1c 淋巴结指定外,肿瘤沉积物 (TD) 的鉴定目前在结直肠癌 (CRC) 分期中作用有限。本研究的目的是确定原发性 CRC 患者中 TD 除了美国癌症联合委员会 (AJCC) N1c 分期之外的预后影响。
方法:从国家癌症研究所的监测、流行病学和最终结果数据库中确定了 2010 年至 2019 年间诊断为 I-III 期原发性 CRC 的患者。使用 Kaplan-Meier 方法和多变量 Cox 比例风险回归分析计算按 TD 状态和淋巴结 (N) 状态分层的癌症特异性生存 (CSS)。
结果:总共确定了 147783 例原发性 CRC 患者。15444 例患者 (10.5%) 存在 TD。TD 的存在与不良肿瘤特征显著相关,包括晚期病理分期、淋巴结状态和转移状态。TD 的存在与较差的 CSS 相关 (风险比 [HR],3.12;95%置信区间 [CI],3.02-3.22),就像每个特定的 N 类别一样 (例如,N2a 和 TD 阴性 [HR,2.50;95% CI,2.37-2.64] vs. N2a 和 TD 阳性 [HR,3.75;95% CI,3.49-4.03])。与单个 TD 相比,每个给定的 N 类别中存在多个 TD 也与 CSS 降低相关 (例如,N2a 有一个 TD [HR,3.09;95% CI,2.65-3.61] vs. N2a 有两个或更多 TD [HR,4.32;95% CI,3.87-4.82])。
结论:TD 被确定为 CRC 患者预后不良的独立预测因子。TD 的存在赋予了截然不同的 CSS,并为 CRC 患者提供了重要的预后信息,值得进一步研究作为 CRC 分期未来迭代中的一个独特变量。
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