Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1699-1710
Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1699
Prognostic impact of tumor deposits on overall survival in colorectal cancer: Based on Surveillance, Epidemiology, and End Results database
Wen-Xiao Wu, Da-Kui Zhang, Shao-Xuan Chen, Zhi-Yong Hou, Bai-Long Sun, Li Yao, Jian-Zheng Jie
Wen-Xiao Wu, Jian-Zheng Jie, Department of Surgery, Graduate School of Peking Union Medical College, Beijing 100730, China
Wen-Xiao Wu, Da-Kui Zhang, Shao-Xuan Chen, Zhi-Yong Hou, Bai-Long Sun, Li Yao, Jian-Zheng Jie, Department of Colorectal Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Jie JZ and Wu WX designed the study; Wu WX, Zhang DK and Chen SX acquired data; Wu WX and Hou ZY analyzed and interpreted data; Wu WX, Sun BL and Yao L drafted the manuscript.
Supported by the Scientific and Technological Project of Qinghai Province, China, No. 2015-ZJ-742.
Institutional review board statement: The current study relied on the SEER cancer registry, which did not require further approval of institutional review aboard.
Informed consent statement: This study was exempt from informed consent.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Zheng Jie, MD, Doctor, Department of Colorectal Surgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China. dakuizhang2021@126.com
Received: April 19, 2022
Peer-review started: April 19, 2022
First decision: May 11, 2022
Revised: May 18, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: September 15, 2022
Processing time: 143 Days and 2.3 Hours
Abstract
BACKGROUND

In colorectal cancer, tumor deposits (TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases (LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately.

AIM

To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count.

METHODS

The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival (OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs.

RESULTS

Overall, 103755 patients were enrolled with 14131 (13.6%) TD-positive and 89624 (86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3% (95%CI, 46.5%-48.1%) and 77.5% (95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS (hazard ratio, 1.35; 95%CI, 1.31-1.38; P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965 (4.4%) N1 patients were restaged as pN2, with worse outcomes than patients restaged as pN1 (3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively; P < 0.0001).

CONCLUSION

TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.

Keywords: Extranodal extension; Colorectal neoplasms; Prognosis; Neoplasm staging; Surveillance, Epidemiology, and End Results program

Core Tip: We evaluated the predictive value of tumor deposits (TDs) for overall survival (OS) in patients with colorectal cancer based on a collection of 103755 patients derived from Surveillance, Epidemiology, and End Results database, including TD-negative and TD-positive subpopulations with Cox proportional hazard model. The sensitivity analyses were performed to detect outcome robustness. TD was an independent prognostic factor for OS. We also performed exploratory analysis to evaluate the effect of TD addition to the lymph node metastases count in tumor, node and metastasis-stage III subpopulations. The outcomes of subgroup analysis investigating the different risk factor profiles indicated that TDs may affect survival through more than one approach.