Prognostic significance of tumor deposit counts in stage III colorectal cancer based on T/N staging and chemotherapy status: A retrospective cohort study

IF 1.4 Q3 SURGERY

Surgery open science Pub Date : 2025-02-22 DOI:10.1016/j.sopen.2025.02.004

Chenxiao Zheng MD , Lingsha Xu MD , Binbin Ou MD , Ibrahim Mohamed Bakour Abdourahaman MD , Xuanqin Chen MD , Hangjia Xu MD , Yating Zheng MD , Yifei Pan MD

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Abstract

Background

We aimed to evaluate the impact of tumor deposit (TD) count on cancer-specific survival (CSS) and disease-free survival (DFS) in stage III colorectal cancer (CRC) patients stratified by T and N staging, and further explore its impact on chemotherapy effect.

Method

We determined the optimal TD cut-off value for stage III CRC patients from the SEER database utilizing X-tile analysis, and retrospectively analyzed the clinicopathological data of 443 patients from the First Affiliated Hospital of Wenzhou Medical University from 2019 to 2020. Chi-square (χ2) tests compared categorical variables. Kaplan–Meier assessed CSS and DFS. Cox regression model evaluated prognostic factors on CSS and DFS.

Results

2TD is the optimal cutoff value for prognosis in Stage III CRC, in the low-risk group (T1-T3 and N1), ≥3TD patients faced higher cancer-specific mortality (HR = 3.445, 95%CI = 1.254–9.465, P = 0.017) and recurrence risks (HR = 1.934, 95%CI = 1.095–3.416, P = 0.024) vs. 1-2TD, while 1-2TD and no-TD patients showed no difference in survival. In the high-risk group (T4 or N2), both ≥3TD and 1-2TD patients had poor prognosis. Chemotherapy reduced cancer-specific mortality in both groups (1-2TD: HR = 0.347, 95%CI = 0.138–0.870, P = 0.024; ≥3TD: HR = 0.272, 95%CI = 0.077–0.960, P = 0.043) but did not significantly improve recurrence risk (1-2TD: P = 0.177; ≥3TD: P = 0.058).

Conclusion

TD indicates poor prognosis in stage III CRC, with ≥3 TD significantly worsening survival, yet the prognosis remains poor in TD-positive patients with high-risk (T4 or N2) regardless of TD count. Moreover, TD count does not influence chemotherapy's mortality benefit.

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基于T/N分期和化疗状态的III期结直肠癌肿瘤沉积物计数的预后意义：一项回顾性队列研究

本研究旨在评价肿瘤沉积（tumor deposit， TD）计数对按T、N分期的III期结直肠癌（CRC）患者癌症特异性生存（cancer specific survival， CSS）和无病生存（disease-free survival， DFS）的影响，并进一步探讨其对化疗效果的影响。方法利用X-tile分析从SEER数据库中确定III期CRC患者的最佳TD截断值，并回顾性分析温州医科大学第一附属医院2019 - 2020年443例患者的临床病理资料。卡方（χ2）检验比较分类变量。Kaplan-Meier评估CSS和DFS。Cox回归模型评估CSS和DFS的预后因素。结果2td是III期结直肠癌预后的最佳临界值，在低危组（T1-T3和N1）中，≥3TD患者的肿瘤特异性死亡率（HR = 3.445, 95%CI = 1.254 ~ 9.465, P = 0.017）和复发风险（HR = 1.934, 95%CI = 1.095 ~ 3.416, P = 0.024）高于1-2TD患者，而1-2TD与无td患者的生存率无差异。在高危组（T4或N2）中，≥3TD和1-2TD患者预后均较差。化疗降低了两组癌症特异性死亡率(1-2TD: HR = 0.347, 95%CI = 0.138-0.870, P = 0.024；≥3TD: HR = 0.272, 95%CI = 0.077 ~ 0.960, P = 0.043)，但未显著提高复发风险(1 ~ 2td: P = 0.177；≥3td: p = 0.058)。结论TD提示III期结直肠癌预后较差，TD≥3显著加重生存期，但无论TD计数如何，TD阳性的高危患者（T4或N2）预后仍较差。此外，总淋巴细胞计数不影响化疗的死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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