Prognostic impact and independent significance of tumor deposits in early-stage colon cancer: a population-based cohort study.

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

International Journal of Colorectal Disease Pub Date : 2025-06-26 DOI:10.1007/s00384-025-04908-8

Bilal Turan, Ahmet Necati Sanli, Deniz Esin Tekcan Sanli, Serdar Acar

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引用次数: 0

Abstract

Background: Tumor deposits (TD) are well-established prognostic markers in advanced-stage colorectal cancer (CRC), but their independent significance in early-stage disease remains unclear. Current staging systems do not account for TD in node-negative CRC, despite emerging evidence suggesting a potential impact on survival. This study aimed to assess the prognostic impact of TD in early-stage (T1-T3, N0) colon cancer using a large population-based cohort and advanced statistical methods.

Methods: A retrospective cohort study was conducted using the SEER database (2010-2021), including 111,106 patients with early-stage (T1-T3) colon cancer, of whom 4055 (3.6%) were TD-positive. To minimize baseline imbalances, propensity score matching (1:3 nearest-neighbor; caliper = 0.2) was applied. Overall survival (OS) and disease-specific survival (DSS) were assessed using the Kaplan-Meier analysis and compared with log-rank tests. Multivariate Cox regression was performed to evaluate the independent prognostic impact of TD status in both unmatched and matched cohorts.

Results: TD-positive patients demonstrated significantly worse overall survival (OS) and disease-specific survival (DSS) compared to TD-negative patients (log-rank p < 0.001). In the unmatched cohort, TD positivity was independently associated with reduced OS (HR: 1.56, 95% CI: 1.48-1.65) and DSS (HR: 2.33, 95% CI: 2.14-2.54; both p < 0.001). These associations remained significant after propensity score matching (OS: HR: 1.44, 95% CI: 1.35-1.54; DSS: HR: 2.17, 95% CI: 1.97-2.40; both p < 0.001).

Conclusion: TD is an independent prognostic factor in early-stage colon cancer, warranting closer surveillance and reconsideration of treatment strategies. These findings suggest that TD should be integrated into risk stratification models, challenging current staging paradigms.

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早期结肠癌肿瘤沉积对预后的影响及其独立意义：一项基于人群的队列研究。

背景：肿瘤沉积物（Tumor deposits， TD）是晚期结直肠癌（CRC）公认的预后标志物，但其在早期疾病中的独立意义尚不清楚。目前的分期系统没有考虑到淋巴结阴性CRC的TD，尽管新出现的证据表明其对生存的潜在影响。本研究旨在通过基于大量人群的队列研究和先进的统计学方法，评估TD对早期（T1-T3, N0）结肠癌预后的影响。方法：采用SEER数据库（2010-2021）进行回顾性队列研究，纳入111,106例早期（T1-T3）结肠癌患者，其中4055例（3.6%）为td阳性。为了最小化基线失衡，倾向评分匹配(1:3最近邻；卡尺= 0.2)。采用Kaplan-Meier分析评估总生存期（OS）和疾病特异性生存期（DSS），并与log-rank检验进行比较。采用多变量Cox回归来评估未匹配和匹配队列中TD状态的独立预后影响。结果：与TD阴性患者相比，TD阳性患者的总生存期（OS）和疾病特异性生存期（DSS）明显更差（log-rank p）。结论：TD是早期结肠癌的独立预后因素，需要更密切的监测和重新考虑治疗策略。这些发现表明，TD应纳入风险分层模型，挑战当前的分期范式。

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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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.