Prognostic impact of tumor deposits on overall survival in colorectal cancer: Based on Surveillance, Epidemiology, and End Results database

doi:10.4251/wjgo.v14.i9.1699

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World Journal of Gastrointestinal Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1699-1710
Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1699

Table 1 Characteristics of patients according to the presence and absence of tumor deposits

	Tumor deposits		P value
	No (89624)	Yes (14131)	P value
Sex			0.827
Female	43569 (48.6%)	6855 (48.5%)
Male	46055 (51.4%)	7276 (51.5%)
Race			0.420
White	70019 (78.1%)	11015 (77.9%)
Black	10345 (11.5%)	1681 (11.9%)
Others	9260 (10.3%)	1435 (10.2%)
Age group, yr			< 0.001^a
< 45	5740 (6.40%)	1231 (8.71%)
45-75	58860 (65.7%)	9387 (66.4%)
≥ 75	25024 (27.9%)	3513 (24.9%)
TNM-stage			< 0.001^a
Ι	24816 (27.7%)	111 (0.79%)
ΙΙ	29374 (32.8%)	825 (5.84%)
ΙΙΙ	26627 (29.7%)	7697 (54.5%)
ΙV	8807 (9.83%)	5498 (38.9%)
T-stage			< 0.001^a
T1	15480 (17.3%)	181 (1.28%)
T2	14312 (16.0%)	482 (3.41%)
T3	47654 (53.2%)	7890 (55.8%)
T4	12178 (13.6%)	5578 (39.5%)
N-stage			< 0.001^a
N0	56512 (63.1%)	1247 (8.82%)
N1	22127 (24.7%)	6582 (46.6%)
N2	10985 (12.3%)	6302 (44.6%)
M-stage			< 0.001^a
M0	80817 (90.2%)	8633 (61.1%)
M1	8807 (9.83%)	5498 (38.9%)
Liver metastasis			< 0.001^a
No	82821 (92.4%)	10377 (73.4%)
Yes	6443 (7.19%)	3627 (25.7%)
Unknown	360 (0.40%)	127 (0.90%)
Lung metastasis			< 0.001^a
No	87677 (97.8%)	13053 (92.4%)
Yes	1526 (1.70%)	893 (6.32%)
Unknown	421 (0.47%)	185 (1.31%)
Site			< 0.001^a
Colon	71779 (80.1%)	11697 (82.8%)
Rectum	16603 (18.5%)	2148 (15.2%)
Unknown	1242 (1.39%)	286 (2.02%)
CEA			< 0.001^a
Normal	32166 (35.9%)	3543 (25.1%)
Elevated	20936 (23.4%)	5705 (40.4%)
Borderline	279 (0.31%)	48 (0.34%)
Unknown	36243 (40.4%)	4835 (34.2%)
Perineural invasion			< 0.001^a
Negative	75025 (83.7%)	8437 (59.7%)
Positive	7301 (8.15%)	4659 (33.0%)
Unknown	7298 (8.14%)	1035 (7.32%)

^aP < 0.05.

TNM: Tumor, node and metastasis; CEA: Carcinoembryonic antigen.

Table 2 Overall survival univariate and multivariate Cox models of baseline characteristics

	Univariate Cox models			Multivariate Cox model
	Events/total	HR (95%CI)	P value	Events/total	HR (95%CI)	P value
Sex			0.3665
Female	19008/50424	Reference
Male	20358/53331	1.01 (0.99-1.03)	0.3665
Race			< 0.0001^a			< 0.0001^a
White	30958/81034	Reference		27279/73091	Reference
Black	5049/12026	1.14 (1.11-1.17)	< 0.0001^a	4440/10821	1.19 (1.16-1.23)	< 0.0001^a
Others	3359/10695	0.80(0.77-0.83)	<.0001^a	2926/9552	0.83(0.80-0.86)	<.0001^a
Age group, yr			< 0.0001^a			< 0.0001^a
< 45	1866/6971	Reference		1627/6276	Reference
45-75	20956/68247	1.17 (1.11-1.22)	< 0.0001^a	18394/61529	1.49 (1.42-1.57)	< 0.0001^a
≥ 75	16544/28537	2.78 (2.65-2.92)	< 0.0001^a	14624/25659	4.40 (4.17-4.63)	< 0.0001^a
TNM-stage			< 0.0001^a			< 0.0001^a
Ι	4709/24927	Reference		4154/22321	Reference
ΙΙ	9334/30199	1.79 (1.73-1.85)	< 0.0001^a	8362/27688	0.96 (0.89-1.02)	0.2060
ΙΙΙ	13498/34324	2.46 (2.38-2.55)	< 0.0001^a	12086/31183	1.32 (1.21-1.43)	< 0.0001^a
ΙV	11825/14305	9.08 (8.77-9.40)	< 0.0001^a	10043/12272	3.27 (2.99-3.56)	< 0.0001^a
T-stage			< 0.0001^a			< 0.0001^a
T1	2794/15661	Reference		2259/13476	Reference
T2	3477/14794	1.35 (1.29-1.42)	< 0.0001^a	3167/13728	1.18 (1.12-1.25)	< 0.0001^a
T3	21562/55544	2.52 (2.42-2.62)	< 0.0001^a	19171/50529	1.71 (1.59-1.83)	< 0.0001^a
T4	11533/17756	5.80 (5.57-6.05)	< 0.0001^a	10048/15731	2.83 (2.63-3.05)	< 0.0001^a
N-stage			< 0.0001^a			< 0.0001^a
N0	16014/57759	Reference		14081/52146	Reference
N1	12199/28709	1.73 (1.69-1.78)	< 0.0001^a	10718/25885	0.96 (0.91-1.02)	0.1880
N2	11153/17287	3.38 (3.30-3.47)	< 0.0001^a	9846/15433	1.44 (1.36-1.53)	< 0.0001^a
M-stage			< 0.0001^a
M0	27541/89450	Reference
M1	11825/14305	5.05 (4.94-5.16)	< 0.0001^a
Liver metastasis			< 0.0001^a			< 0.0001^a
No	30670/93198	Reference		27418/84728	Reference
Yes	8406/10070	4.67(4.56-4.79)	< 0.0001^a	7227/8736	1.33(1.28-1.39)	< 0.0001^a
Lung metastasis			< 0.0001^a			< 0.0001^a
No	36847/100730	Reference		32838/91390	Reference
Yes	2119/2419	4.62 (4.42-4.83)	< 0.0001^a	1807/2074	1.32 (1.25-1.38)	< 0.0001^a
Site			< 0.0001^a
Colon	32774/83476	Reference
Rectum	5782/18751	0.71 (0.69-0.73)	< 0.0001^a
CEA			< 0.0001^a
Normal	9708/35709	Reference
Elevated	14098/26641	2.46 (2.40-2.53)	< 0.0001^a
Borderline	125/327	1.51 (1.26-1.80)	0.0001^a
Perineural invasion			< 0.0001^a			< 0.0001^a
Negative	28478/83462	Reference		27655/81868	Reference
Positive	7260/11960	2.32 (2.26-2.38)	< 0.0001^a	6990/11596	1.22 (1.19-1.26)	< 0.0001^a
Tumor deposits			< 0.0001^a			< 0.0001^a
No	30165/89624	Reference		26523/80813	Reference
Yes	9201/14131	2.73 (2.67-2.80)	< 0.0001^a	8122/12651	1.35 (1.31-1.38)	< 0.0001^a

^aP < 0.05.

TNM: Tumor, node and metastasis; CEA: Carcinoembryonic antigen.

Table 3 Sensitivity analysis for effect of tumor deposits on overall survival

Analysis	HR (95%CI)	P value
Univariable analysis	2.73 (2.67-2.80)	< 0.0001^a
Multivariable analysis	1.35 (1.31-1.38)	< 0.0001^a
Propensity score analysis (with inverse probability of treatment weighting)	1.29 (1.19-1.39)	< 0.0001^a
Multiple imputation for missing data analysis	1.39 (1.35-1.42)	< 0.0001^a

^aP < 0.05.

HR: Hazard ratio.

Table 4 Univariable Cox analysis in patients with and without tumor deposits

	TDs (no)			TDs (yes)			RHR	P value
	Events/total	HR (95%CI)	P value	Events/total	HR (95%CI)	P value	RHR	P value
Sex			0.1265			0.0528
Female	14534/43569	Reference		4474/6855	Reference
Male	15631/46055	1.02 (1.00-1.04)	0.1265	4727/7276	0.96 (0.92-1.00)	0.0528
Race			< 0.0001^a			< 0.0001
White	23736/70019	Reference		7222/11015	Reference
Black	3904/10345	1.16 (1.12-1.20)	< 0.0001^a	1145/1681	1.06 (1.00-1.13)	0.0536	0.91 (0.85-0.98)	0.0118^a
Others	2525/9260	0.79 (0.76-0.82)	< 0.0001^a	834/1435	0.83 (0.77-0.89)	< 0.0001^a	1.05 (0.97-1.14)	0.2380
Age group, yr			< 0.0001^a			< 0.0001^a
< 45	1201/5740	Reference		665/1231	Reference
45-75	15238/58860	1.26 (1.19-1.34)	< 0.0001^a	5718/9387	1.23 (1.13-1.33)	< 0.0001^a	0.98 (0.88-1.08)	0.6384
≥ 75	13726/25024	3.37 (3.18-3.58)	< 0.0001^a	2818/3513	2.34 (2.15-2.55)	< 0.0001^a	0.69 (0.63-0.77)	< 0.0001^a
TNM-stage			< 0.0001^a			< 0.0001^a
Ι	4683/24816	Reference		26/111	Reference
ΙΙ	8962/29374	1.77 (1.70-1.83)	< 0.0001^a	372/825	2.40 (1.61-3.57)	< 0.0001^a	1.36 (0.91-2.02)	0.1362
ΙΙΙ	9545/26627	2.17 (2.09-2.24)	< 0.0001^a	3953/7697	3.05 (2.08-4.49)	< 0.0001^a	1.41 (0.96-2.07)	0.0836
ΙV	6975/8807	8.05 (7.76-8.36)	< 0.0001^a	4850/5498	9.25 (6.29-13.6)	< 0.0001^a	1.15 (0.78-1.69)	0.4840
T-stage			< 0.0001^a			< 0.0001^a
T1	2726/15480	Reference		68/181	Reference
T2	3321/14312	1.35 (1.29-1.42)	< 0.0001^a	156/482	0.84 (0.63-1.11)	0.2246	0.62 (0.47-0.83)	0.0012^a
T3	17029/47654	2.30 (2.20-2.39)	< 0.0001^a	4533/7890	1.84 (1.45-2.34)	< 0.0001^a	0.80 (0.63-1.02)	0.0602
T4	7089/12178	4.84 (4.63-5.05)	< 0.0001^a	4444/5578	3.69 (2.90-4.68)	< 0.0001^a	0.76 (0.60-0.97)	0.0286^a
N-stage			< 0.0001^a			< 0.0001^a
N0	15350/56512	Reference		664/1247	Reference
N1	8434/22127	1.53 (1.49-1.57)	< 0.0001^a	3765/6582	1.14 (1.05-1.24)	0.0014^a	0.75 (0.68-0.81)	< 0.0001^a
N2	6381/10985	2.86 (2.77-2.94)	< 0.0001^a	4772/6302	1.99 (1.83-2.16)	< 0.0001^a	0.70 (0.64-0.76)	< 0.0001^a
M-stage			< 0.0001^a			< 0.0001^a
M0	23190/80817	Reference		4351/8633	Reference
M1	6975/8807	4.90 (4.77-5.04)	< 0.0001^a	4850/5498	3.13 (3.00-3.27)	< 0.0001^a	0.64 (0.61-0.67)	< 0.0001^a
Site			< 0.0001^a			< 0.0001^a
Colon	24983/71779	Reference		7791/11679	Reference
Rectum	4595/16603	0.74 (0.71-0.76)	< 0.0001^a	1187/2148	0.66 (0.62-0.71)	< 0.0001^a	0.89 (0.83-0.96)	0.0030^a
CEA			< 0.0001^a			< 0.0001^a
Normal	7926/32166	Reference		1782/3543	Reference
Elevated	9908/20936	2.34 (2.27-2.41)	< 0.0001^a	4190/5705	1.95 (1.84-2.06)	< 0.0001^a	0.83 (0.78-0.89)	< 0.0001^a
Borderline	95/279	1.47 (1.20-1.80)	0.0002^a	30/48	1.32 (0.92-1.89)	0.1343	0.90 (0.59-1.36)	0.6100
Perineural invasion			< 0.0001^a			< 0.0001^a
Negative	23417/75025	Reference		5061/8437	Reference
Positive	3845/7301	2.05 (1.98-2.12)	< 0.0001^a	3415/4659	1.46 (1.40-1.52)	< 0.0001^a	0.71 (0.68-0.75)	< 0.0001^a
Liver metastasis			< 0.0001^a			< 0.0001^a
No	24811/82821	Reference		5859/10377	Reference
Yes	5164/6443	4.73 (4.59-4.88)	< 0.0001^a	3242/3627	2.66 (2.54-2.78)	< 0.0001^a	0.56 (0.53-0.59)	< 0.0001^a
Lung metastasis			< 0.0001^a			< 0.0001^a
No	28622/87677	Reference		8225/13053	Reference
Yes	1297/1526	4.97 (4.70-5.25)	< 0.0001^a	822/893	2.40 (2.23-2.58)	< 0.0001^a	0.48 (0.44-0.53)	< 0.0001^a

^aP < 0.05.

TNM: Tumor, node and metastasis; CEA: Carcinoembryonic antigen; HR: Hazard ratio; TDs: Tumor deposits.

Table 5 N1 colorectal cancers after being restaged

Initial N stage	Restaged N1	Restaged N2	Total
N1a/b	18077	752	18820
N1c	1003	133	1136
Total	19080	885	19965

Citation: Wu WX, Zhang DK, Chen SX, Hou ZY, Sun BL, Yao L, Jie JZ. Prognostic impact of tumor deposits on overall survival in colorectal cancer: Based on Surveillance, Epidemiology, and End Results database. World J Gastrointest Oncol 2022; 14(9): 1699-1710
URL: https://www.wjgnet.com/1948-5204/full/v14/i9/1699.htm
DOI: https://dx.doi.org/10.4251/wjgo.v14.i9.1699