Heng Yixin, Huang Mudan, Xu Jiaxin, Wu Xiaoyu, Huang Ning, Cao Yinghao, Qin Le
Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832008, P. R. China.
Department of Radiation Oncology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group, Shenzhen, 5 18000, China.
BMC Gastroenterol. 2025 Mar 11;25(1):154. doi: 10.1186/s12876-025-03713-5.
To evaluate the prognostic value of the presence and number of tumor deposits (TDs) and the combination of TDs and number of positive lymph nodes (PLNs) in patients undergoing colorectal cancer (CRC) surgery, and to modify N staging.
The clinical data of 1470 patients with stage I-IV CRC who underwent surgery in Wuhan Union Hospital from February 2014 to May 2018 were collected. The optimal cutoff value for TD + PLNs was obtained using X-tile software, and patients were regrouped accordingly. Cox univariate and multivariate analysis were used to screen the factors affecting the prognosis of patients. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive ability of independent prognostic factors for overall survival (OS) and disease-free survival (DFS) of patients.
The presence of TD was associated with poor OS (HR = 2.478, 95%CI: 1.794-3.422, P<0.001) and DFS (HR = 2.516, 95%Cl: 1.874-3.377, P<0.001). Combined with TD and PLNs, a total of 128 of 395 N1 patients were reclassified re-staged as N2(TD + PLNs ≥ 3), which had a worse prognosis than those diagnosed with N1. Compared with Tumor Node Metastasis stage and TD number, the multivariate model constructed using independent prognostic factors showed better predictive power for OS (AUC:0.769 vs. 0.681 vs. 0.650) and DFS (AUC:0.757 vs. 0.702 vs. 0.650).
TD significantly affects the long-term prognosis of CRC patients. Combining TD and PLNs to redefine the tumor staging of CRC patients can improve the accuracy of long-term prognosis of surgical patients.
评估肿瘤结节（TDs）的存在及数量以及TDs与阳性淋巴结数量（PLNs）的组合对接受结直肠癌（CRC）手术患者的预后价值，并修订N分期。
收集2014年2月至2018年5月在武汉协和医院接受手术的1470例I-IV期CRC患者的临床资料。使用X-tile软件获得TD+PLNs的最佳截断值，并据此对患者进行重新分组。采用Cox单因素和多因素分析筛选影响患者预后的因素。采用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估独立预后因素对患者总生存（OS）和无病生存（DFS）的预测能力。
TD的存在与较差的OS（HR=2.478，95%CI：1.794-3.422，P<0.001）和DFS（HR=2.516，95%Cl：1.874-3.377，P<0.001）相关。结合TD和PLNs，395例N1患者中有128例重新分类为N2（TD+PLNs≥3），其预后比诊断为N1的患者更差。与肿瘤淋巴结转移分期和TD数量相比，使用独立预后因素构建的多变量模型对OS（AUC：0.769 vs. 0.681 vs. 0.650）和DFS（AUC：0.757 vs. 0.702 vs. 0.650）显示出更好的预测能力。
TD显著影响CRC患者的长期预后。结合TD和PLNs重新定义CRC患者的肿瘤分期可提高手术患者长期预后的准确性。
