Stage I-III colon cancer patients with tumor deposits behave similarly to stage IV patients. Cross-section analysis of 392 patients

Tumor deposits should not be placed in the M category of TNM: A comparative survival analysis using SEER data

Tumor deposits (TD) are tumor nodules in the lymphatic drainage area of colorectal cancer patients, and they are currently classified in the N category in the TNM classification. However, due to the associated poor prognosis, some small cohort studies suggest that TD belong in the M category. A retrospective study using The Surveillance, Epidemiology, and End Results program (SEER) data was performed in Stages III and IV colon carcinoma (CC) patients to evaluate the prognostic impact of TD. In multivariate analysis, TD have significantly negative effect on survival in both stages (Stage III HR = 1.4 [95% CI 1.4-1.5] and Stage IV HR = 1.3 [95% CI 1.2-1.3]). In Stage III, 5-year overall survival (OS) for patients with TD 49%, whereas it was 64% for patients without TD (p < .001). Additionally, in Stage IV patients without TD, the 5-year OS rates are superior at 21% compared to patients with TD, who show 5-year OS rate of 10% (p < .001). Stage III patients with TD (5-year OS 49%) have a significantly better prognosis compared to Stage IV patients (5-year OS 17%, p < .001). Therefore, despite the previous suggestions, this large scale study (n = 52,332) on outcomes in CC does not support the classification of TD in Stage IV.

Clinical and Pathologic Predictors of Tumor Deposits in Colorectal Cancer

BACKGROUND

Tumor deposits (TDs) are a special metastatic pattern of colorectal cancer (CRC). This study aims to explore the pathological characteristics of TD and find out the risk factors of TD in CRC.

METHODS

TDs cases of CRC were selected and validated by HE staining. The correlation between TDs and T stages, N stages, and microsatellite instability was calculated by the chi-squared (χ2) test.

RESULTS

A total of 2553 patients with colorectal cancer undergoing intestinal resection were included in this study. Two hundred fifty-nine cases of TDs patients were included. The positive rate of TDs was 1.9% (2/105) in T1, 3.8% (10/266) in T2, 11% (231/2305) in T3, and 22.8% (16/77) in T4. T3 and T4 were more prone to TDs than T1 and T2, but there was no difference between T3 and T4. The positive rate of TDs was 7.2% (107/1491) in N0, 14.3% (152/1062) in N + , and N + was more prone to TDs than N0. The positive rate of TDs was 10.5% (256/2432) in MSS, 2.5% (3/121) in MSI, and MSS was more prone to TDs than MSI. Multivariate analysis showed lymph node invasion, T stage, and MSS were independent risk factors for TDs.

CONCLUSION

Lymph node invasion, T stage, and MSS were independent risk factors for TDs.

Presence of tumor deposits is a strong indicator of poor outcome in patients with stage III colorectal cancers undergoing radical surgery

BACKGROUND

Tumor deposits (TDs) are emerging as an adverse prognostic factor in colorectal cancers (CRCs). However, TDs are somewhat neglected in the current staging system. It has been proposed either to add the TD count to the number of metastatic lymph nodes or to consider TDs as distant metastases; however, the scientific basis for these proposals seems questionable. This study aimed to investigate a new staging system.

METHODS

A total of 243 consecutive patients with stage III CRC who were undergoing curative resection and adjuvant chemotherapy were included. Each substage of stage III TNM was split according to the absence or presence of TDs. Receiver operating characteristic (ROC) curves and bootstrap methods were used to compare the current vs the new competing staging system in terms of oncologic outcome prediction.

RESULTS

A high rate of TDs was recorded (124 cases [51%]). TDs were correlated with other adverse prognostic indicators, particularly vascular and perineural invasions, and showed a negative correlation with the number of removed lymph nodes, suggesting a possible multimodal origin. In addition, TDs were confirmed to have a negative impact on oncologic outcome, regardless of their counts. Compared with the current staging system, the new classification displayed higher values at survival ROC analysis, a significantly better stratification of patients, and effective identification of patients at high risk of recurrence.

CONCLUSIONS

TDs negatively affect the prognosis in CRCs. A revision of the staging system could be useful to optimize treatments. The proposed new classification is easy to implement and more accurate than the current one. This study was registered online on the ClinicalTrials.gov website under the following identifier: NCT05923450.

Transcriptomics and proteomics reveal distinct biology for lymph node metastases and tumour deposits in colorectal cancer

Both lymph node metastases (LNMs) and tumour deposits (TDs) are included in colorectal cancer (CRC) staging, although knowledge regarding their biological background is lacking. This study aimed to compare the biology of these prognostic features, which is essential for a better understanding of their role in CRC spread. Spatially resolved transcriptomic analysis using digital spatial profiling was performed on TDs and LNMs from 10 CRC patients using 1,388 RNA targets, for the tumour cells and tumour microenvironment. Shotgun proteomics identified 5,578 proteins in 12 different patients. Differences in RNA and protein expression were analysed, and spatial deconvolution was performed. Image-based consensus molecular subtype (imCMS) analysis was performed on all TDs and LNMs included in the study. Transcriptome and proteome profiles identified distinct clusters for TDs and LNMs in both the tumour and tumour microenvironment segment, with upregulation of matrix remodelling, cell adhesion/motility, and epithelial-mesenchymal transition (EMT) in TDs (all p < 0.05). Spatial deconvolution showed a significantly increased abundance of fibroblasts, macrophages, and regulatory T-cells (p < 0.05) in TDs. Consistent with a higher fibroblast and EMT component, imCMS classified 62% of TDs as poor prognosis subtype CMS4 compared to 36% of LNMs (p < 0.05). Compared to LNMs, TDs have a more invasive state involving a distinct tumour microenvironment and upregulation of EMT, which are reflected in a more frequent histological classification of TDs as CMS4. These results emphasise the heterogeneity of locoregional spread and the fact that TDs should merit more attention both in future research and during staging. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Risk factors predict microscopic extranodal tumor deposits in advanced stage III colon cancer patients

BACKGROUND

Colorectal cancer is a frequent cause of cancer-related mortality in patients with lymph node or distant metastases. Pericolonic tumor deposits (TDs) are considered prognostically distinct from lymph node metastases.

AIM

To investigate risk factors for extranodal TDs in stage III colon cancer.

METHODS

This was a retrospective cohort study. We selected 155 individuals diagnosed with stage III colon cancer from the database of the Cancer Registry of the Tri-Service General Hospital. The patients were allocated into the groups with/without N1c. Multivariate Cox regression analysis and Kaplan-Meier method were done. The primary outcomes investigate the association between the covariates and extranodal TDs, and prognostic significance of the covariates regarding the survival.

RESULTS

There were 136 individuals in the non-N1c group and 19 individuals in the N1c group. Patients with lymphovascular invasion (LVI) had a higher risk of TDs. Overall survival rates of patients with and without LVI were 6.64 years and 8.61 years, respectively (P = 0.027). The N1c patients without LVI had higher overall survival than those who with LVI (7.73 years vs 4.42 years, P = 0.010).

CONCLUSION

Patients having stage III colon cancer with LVI have a higher probability of having TDs than those with stage III colon cancer without LVI. Stage III colon cancer patients with TDs and LVI could have poor prognosis and outcome.

Efficacy of jianpi huatan granule in reducing colorectal cancer metastasis and recurrence after radical resection and adjuvant chemotherapy: Study protocol for a randomised, double-blind, placebo-controlled, multicentre trial

Background: The high incidence and mortality rates of colorectal cancer (CRC) are a severe challenge in China. In patients with stage III and high-risk stage II CRC after radical resection and postoperative adjuvant chemoradiotherapy, 40–60% experience recurrence and metastasis. Several years of clinical practice have shown that traditional Chinese medicine, including Jianpi Huatan granule (JHG), effectively prevents stage III and high-risk stage II CRC recurrence and metastasis after radical resection and postoperative standard adjuvant chemotherapy. However, high-level systematic plans and evidence-based medicine are lacking in this regard. Therefore, this randomised control trial aimes to determine the efficacy of JHG in reducing stage III and high-risk stage II CRC metastasis and recurrence after radical resection and postoperative standard adjuvant chemotherapy.

Methods: This is a multicentre, randomised, double-blind, placebo-controlled clinical trial. Three hundred and fifty patients with stage III or high-risk stage II CRC who completed adjuvant chemotherapy after radical resection will be recruited from eight medical centres in China and randomly assigned to test (n = 175) and control (n = 175) groups at a ratio of 1:1. The test group will receive oral JHG for 3 months, whereas the control group will receive oral placebo for 3 months. The primary outcomes will be the disease-free survival and 1-, 2-, and 3-years metastasis and recurrence rates, whereas the secondary outcomes will be quality of life and circulating tumour cells. The patients will be followed-up monthly during treatment and every 3–6 months thereafter until recurrence, metastasis, death, or the end of the study.

Trial registration: This trial was registered at ClinicalTrials.gov (NCT03716063).

Irregular delay of adjuvant chemotherapy correlated with poor outcome in stage II-III colorectal cancer

AIMS

Adjuvant chemotherapy (ACT) plays an important role in improving the survival of stage II-III colorectal cancer (CRC) patients after curative surgery. However, the prognostic role of irregular delay of ACT (IDacT) for these patients has been less studied.

MATERIALS AND METHODS

A total of 117 stage II-III CRC patients who underwent radical resection and received at least 3 months ACT were enrolled retrospectively. The significance of IDacT, including total delay (TD) and delay per cycle (DpC), in predicting disease-free survival (DFS) was determined using receiver operating characteristic curve (ROC) analysis. The survival differences between the TD, DpC-short and DpC-long subgroups were tested using Kaplan-Meier analysis, and risk factors for prognosis were determined using a Cox proportional hazards model.

RESULTS

Using 35.50 and 3.27 days as the optimal cut-off points for TD and DpC, respectively, ROC analysis revealed that TD and DpC had sensitivities of 43.60% and 59.00% and specificities of 83.30% and 62.80%, respectively, in predicting DFS (both P < 0.05). No differences in the clinicopathological parameters were found between the TD, DpC-short or -long subgroups except histological differentiation in different TD subgroups and combined T stages in different DpC subgroups (both P = 0.04). Patients in the TD or DpC-long group exhibited significantly worse survival than in the -short group (TD: Log rank = 9.11, P < 0.01; DpC: Log rank = 6.09, P = 0.01). DpC was an independent risk factor for prognosis (HR = 2.54, 95% CI: 1.32-4.88, P = 0.01).

CONCLUSIONS

IDacT had a profound effect on the outcome for stage II-III CRC. Although TD and DpC were significant for the prognosis, DpC was more robust, and patients who presented DpC for a long time had a significantly worse DFS.

Analysis of Threshold Change of Tumor Mutation Burden in Gastric Cancer

Background

The purpose of this study was to investigate the change of tumor mutation burden (TMB) in gastric cancer (GC) and its relationship with prognosis.

Methods

A total of 262 patients with GC from January 2018 to December 2019 were included in this study. All patients were in the advanced stage and were treated with surgical removal of D2 lymph nodes and dissection. Clinical data and gene expression profile data of the GC dataset in The Cancer Genome Atlas were collected. Patients were randomly divided into a high-level group and a low-level group according to the TMB of 8 mutations/Mb. TMB of GC was calculated based on cell mutation data. Cox regression model was used to evaluate the relationship between TMB and prognosis of GC patients.

Results

The total mutation rate of 262GC patients was 92.85%. The top 5 mutant genes were TP53, RB1, ARID1A, KMT2B, and RET. The expression level of TMB in GC patients was statistically significant with age, drinking history, and differentiation type. 94 of the 262 patients died, and 168 survived during the follow-up period. Patients with a high level of TMB had a worse prognosis than those with low level of TMB. The results of univariate and multivariate logistic analysis showed that the overall survival rate of GC patients was statistically significant with age, drinking history, clinical stage, differentiation type, and TMB.

Conclusion

GC patients are often accompanied by changes in TMB, and its expression level is closely related to the degree of pathological differentiation, which is an independent factor affecting the prognosis of GC patients. High TMB value can evaluate the prognosis and provide a reference for the formulation of clinical treatment plans for GC patients.

Prognostic value of tumor deposits in locally advanced rectal cancer: a retrospective study with propensity score matching

BACKGROUND

The actual risks posed by tumor deposits (TDs) in colorectal cancer are still incompletely assessed. We explored the prognostic value of TDs in locally advanced rectal cancer (LARC) patients using propensity score matching (PSM) method.

METHODS

Consecutive LARC patients in Peking University First Hospital between 2011 and 2015 were retrospectively analyzed. Kaplan-Meier methods and Cox proportional hazard regression analysis were conducted to explore prognostic values of TDs. PSM method was conducted to minimize selection bias. The correlation between TDs number and prognosis was explored.

RESULTS

Four hundred and fifty-one LARC patients were recruited, and 78 (17.3%) patients were with TDs. Multivariate Cox analysis identified that the presence of TDs was an independent prognostic risk factor for overall survival (OS) (P = 0.044). PSM identified 76 matched pairs of LARC patients, and Kaplan-Meier curves revealed that patients with TDs experienced worse  OS (log-rank P = 0.0220) and relapse-free survival (RFS) (log-rank P = 0.0117). Subgroup analysis of 50 pairs extracted by PSM from 246 LARC patients with lymph node metastasis (LNM) further proved that TDs were significantly associated with worse OS (log-rank P = 0.0415), and the association was barely significant for RFS (log-rank P = 0.0527). There were non-significant tendencies towards higher mortality in TDs ≥ 2 than TD = 1 group (log-rank P = 0.348 for OS, log-rank P = 0.087 for RFS).

CONCLUSION

Our study manifested that the presence of TDs was an independent risk factor for LARC patients. The prognostic value of TDs for LARC patients with LNM should not be ignored.

N1c colon cancer and the use of adjuvant chemotherapy: a current audit of the National Cancer Database

AIM

Colorectal cancer staging has evolved to define N1c as the presence of tumour deposits without concurrent positive lymph nodes. Work to date reports poor prognosis in N1c colon cancer, with Stage III categorization and adjuvant chemotherapy (AC) recommended. No study has yet evaluated the prevalence, treatment compliance or treatment-related outcomes on a national scale. We aimed to evaluate the prevalence of N1c colon cancer, use, outcomes and factors associated with AC in the USA.

METHOD

The National Cancer Database was reviewed for N1cM0 colon adenocarcinomas that underwent resection from 2010 to 2016. Cases were stratified into 'AC' or 'no AC' cohorts. The Kaplan-Meier method was used to estimate overall survival (OS) and compare the AC and no AC cohorts using the log-rank test. Multivariable logistic regression identified factors associated with AC. The main outcome measures were the prevalence and factors associated with AC use and its impact in N1c disease.

RESULTS

Of the 5684 (1.59% of 357 752) colon adenocarcinomas that were N1c, 55% (n = 3071) received AC. AC significantly improved 1-, 3- and 5-year OS compared with no AC (96.2%, 80%, 67.4% and 72.9%, 48.5%, 33.8%, respectively; P < 0.001). Compared with the no AC group, AC patients were younger, had less comorbidity, were of the male gender and received minimally invasive surgery at an academic treatment centre (all P < 0.05). Socioeconomic and procedural factors significantly impacted the use of AC.

CONCLUSION

In the USA, AC is underutilized in N1c colon cancer despite significantly improved OS. Socioeconomic and procedural factors associated with AC were identified, highlighting disparities in AC use and opportunities to improve oncological outcomes and survival.