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Rodriguez-Justo M. Outcome Prediction in Rectal Cancer Beyond the Current TNM System-An Unmet Need. Dis Colon Rectum 2024; 67:603-605. [PMID: 38147427 DOI: 10.1097/dcr.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Manuel Rodriguez-Justo
- Gastrointestinal Pathology, University College London Hospitals, London, United Kingdom
- Department of Oncopathology, Cancer Institute, University College London, United Kingdom
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Yu Y, Wu J, Wu H, Qiu J, Wu S, Hong L, Xu B, Shao L. Prediction of liver metastasis and recommended optimal follow-up nursing in rectal cancer. Nurs Health Sci 2024; 26:e13102. [PMID: 38402869 DOI: 10.1111/nhs.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/16/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
We aimed to analyze and investigate the clinical factors that influence the occurrence of liver metastasis in locally advanced rectal cancer patients, with an attempt to assist patients in devising the optimal imaging-based follow-up nursing. Between June 2011 and May 2021, patients with rectal cancer at our hospital were retrospectively analyzed. A random survival forest model was developed to predict the probability of liver metastasis and provide a practical risk-based approach to surveillance. The results indicated that age, perineural invasion, and tumor deposit were significant factors associated with the liver metastasis and survival. The liver metastasis risk of the low-risk group was higher at 6-21 months, with a peak occurrence time in the 15th month. The liver metastasis risk of the high-risk group was higher at 0-24 months, with a peak occurrence time in the 8th month. In general, our clinical model could predict liver metastasis in rectal cancer patients. It provides a visualization tool that can aid physicians and nurses in making clinical decisions, by detecting the probability of liver metastasis.
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Affiliation(s)
- Yilin Yu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Junxin Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Haixia Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jianjian Qiu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Shiji Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Liang Hong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Lingdong Shao
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
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Li T, Zhang WH, Liu J, Mao YL, Liu S. Isolated axillary tumor deposit consistent with primary breast carcinoma: A case report. World J Clin Cases 2023; 11:7718-7723. [DOI: 10.12998/wjcc.v11.i31.7718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND We all know that lymph-node metastasis is an important factor for poor clinical outcome in breast cancer prognosis. Tumor deposit refers to a discrete collection of cancer cells that is found in the lymph nodes or other tissues adjacent to the primary tumor site. These tumor deposits are separate from the primary tumor and are often considered as a manifestation of lymph node metastasis. In gastric and colorectal cancer, tumor deposits in the lymph node drainage area have been included as independent prognostic factors. The question arises whether tumor deposits should also be considered as prognostic factors in breast cancer patients. This article aims to provoke some thoughts on this matter through a case study and literature review.
CASE SUMMARY A 70-year-old female patient was found to have a right breast lump for over 2 years. On January 3, 2023, a core needle biopsy of the right breast lump was performed, and the pathology report indicated invasive carcinoma. Subsequently, on January 17, 2023, the patient underwent right breast-conserving surgery, sentinel lymph node biopsy, and right axillary lymph node dissection. The postoperative pathological staging was determined as stage IIB. The patient received chemotherapy, radiotherapy, and endocrine therapy. At present, nearly one year after the surgery, no obvious signs of metastasis have been observed in the follow-up examinations, but the long-term prognosis is still unknown.
CONCLUSION There is a need for increased focus on the matter of tumor deposits in the lymph node drainage region, as well as a requirement for further clinical investigation to ascertain the relevance of tumor deposits in the prognosis of individuals with breast carcinoma.
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Affiliation(s)
- Tian Li
- Department of Breast Surgery, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China
| | - Wei-Hong Zhang
- Department of Breast Surgery, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China
| | - Juan Liu
- Department of Pathology, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China
| | - Yi-Ling Mao
- Department of Radiology, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China
| | - Sheng Liu
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Lin YH, Chen QX, Lu LB, Chen H, Wu JX, Wang XW, Chen YY, Lin Q, Li J, Chen X. Readjustment of nodal staging by integrating tumor deposits and positive lymph nodes in patients with stage III colon cancer: a population-based analysis. Am J Cancer Res 2023; 13:4976-4988. [PMID: 37970348 PMCID: PMC10636666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/29/2023] [Indexed: 11/17/2023] Open
Abstract
Whether tumor deposits (TDs) should be classified as lymph node metastasis or distant metastasis remains controversial. To address this predicament, we conducted this study to identify the predictive value of TDs on the survival of patients diagnosed with stage III colon cancer (CC). 12,904 eligible patients diagnosed with stage III CC between 2010 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The best cutoff point of TD quantity was determined based on the difference in survival. Cox proportional hazards model was employed to perform univariate and multivariate analyses. The Kaplan-Meier method and log-rank test were performed to calculate the differences between overall survival (OS). Our results showed that the number of TDs was a significant prognostic factor in patients with stage III CC (P < 0.0001). We added the number of TDs to the pN stage and devised a new pN stage, there were no significant differences in the survival of npN, except npN2a (P > 0.05). Upon re-staging to the same npN stage, the difference in survival between TDs+ and TDs- disappeared (P > 0.05). The median survival times for N2aTDs > 4 and N2bTDs > 4 were 33 and 37 months, respectively, which were significantly shorter than that of N2TDs- (65 months) and represented the worst survival rates among all groups. In conclusion, the number of TDs indicated a poor prognosis for patients with stage III CC. Incorporating TDs into the pN is feasible to predict prognosis.
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Affiliation(s)
- Yi-Hong Lin
- Fujian Medical UniversityFuzhou, Fujian, China
- Department of Oncology, Fudan University Shanghai Cancer Center (Xiamen)Xiamen, Fujian, China
| | - Qun-Xiang Chen
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Lin-Bin Lu
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Hong Chen
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Jun-Xian Wu
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Xue-Wen Wang
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Ya-Ying Chen
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Qin Lin
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Jie Li
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of The People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical UniversityFuzhou, Fujian, China
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Yang R, Zhao H, Wang X, Ding Z, Tao Y, Zhang C, Zhou Y. Magnetic resonance imaging radiomics modeling predicts tumor deposits and prognosis in stage T3 lymph node positive rectal cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1268-1279. [PMID: 36750477 DOI: 10.1007/s00261-023-03825-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE To develop a magnetic resonance imaging radiomics model to predict tumor deposits (TDs) and prognosis in stage T3 lymph node positive (T3N+) rectal cancer (RC). METHODS This retrospective study included 163 patients with pathologically confirmed T3N + RC from December 2013 to December 2015. The patients were divided into two groups for training and testing. Extracting radiomic features from MR images and selecting features using principal component analysis (PCA), then radiomic scores (rad-scores) were obtained by logistic regression analysis. Finally, a combined TDs prediction model containing rad-scores and clinical features was developed. A receiver operating characteristic (ROC) curve was used to assess the prediction performance. The overall survival (OS) rate in patients with high-risk and low-risk TDs predicted by rad-scores was validated by Kaplan-Meier survival curves. RESULTS Of the 163 patients included, histological TDs was diagnosed in 45 patients. The area under the curve (AUC) of the final model was 0.833 (training) and 0.844 (testing). The patients with rad-scores predicted high-risk were associated with OS. In addition, postoperative adjuvant therapy improved the OS of the high-risk TDs group (P < 0.05). CONCLUSION MRI-based radiomics modeling helps in the preoperative prediction of patients with TDs+ in T3N + RC and provides risk stratification for neoadjuvant therapy. In addition, the rad-scores of TDs could suggest different survival benefits of postoperative adjuvant therapy for T3N + RC patients and guide clinical treatment.
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Affiliation(s)
- Rui Yang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Hongxin Zhao
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China
| | - Zhipeng Ding
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China
| | - Yuqing Tao
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Chunhui Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150081, Heilongjiang, China.
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China.
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Distinguishing mesorectal tumor deposits from metastatic lymph nodes by using diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging in rectal cancer. Eur Radiol 2022; 33:4127-4137. [PMID: 36520180 DOI: 10.1007/s00330-022-09328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study aimed to identify whether apparent diffusion coefficient (ADC) values and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters are helpful in distinguishing mesorectal tumor deposits (TD) from metastatic lymph nodes (MLN) in rectal cancer (RC). METHODS Thirty patients (59 lesions, including 30 TD and 29 MLN) with RC who underwent pretreatment-MRI between February 2016 and August 2018 were enrolled. The morphological features, ADC values, and semi-quantitative parameters of DCE-MRI, including relative enhancement (RE), maximum enhancement (ME), maximum relative enhancement (MRE), time to peak (TTP), wash-in rates (WIR), wash-out rates (WOR), brevity of enhancement (BRE), and area under the curve (AUC) were measured on lesions (TD or MLN) and RC. The parameters were compared between TD and MLN, tumor with and without TD group by using Fisher's exact test, independent-samples t-test, and Mann-Whitney U test. The ratio (lesion-to-tumor) of the parameters was compared between TD and MLN. Receiver operating characteristic curve analysis and binary logistic regression analysis were used to assess the diagnostic ability of single and combined metrics for distinguishing TD from MLN. RESULTS The morphological features, including size, shape, and border, were significantly different between TD and MLN. TD exhibited significantly lower RE, MRE, RE-ratio, MRE-ratio, ADCmin-ratio, and ADCmean-ratio than MLN. RE-ratio showed the highest AUC (0.749) and accuracy (77.97%) among single parameters. The combination of DCE-MRI and DWI parameters together showed higher diagnostic efficiency (AUC = 0.825). CONCLUSIONS Morphological features, ADC values, and DCE-MRI parameters can preoperatively help distinguish TD from MLN in RC. KEY POINTS • DWI and DCE-MRI can facilitate early detection and distinguishing mesorectal TD (tumor deposits) from MLN (metastatic lymph nodes) in rectal cancer preoperatively. • TD has some specific morphological features, including relatively larger size, lower short- to long-axis ratio, irregular shape, and ill-defined border on T2-weighted MR images in rectal cancer. • The combination of ADC values and semi-quantitative parameters of DCE-MRI (RE, MRE) can help to improve the diagnostic efficiency of TD in rectal cancer.
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Liu S, Lin Y, Huang S, Xue S, Huang R, Chen L, Wang C. Identifying the long-term survival beneficiary of chemotherapy for stage N1c sigmoid colon cancer. Sci Rep 2022; 12:16909. [PMID: 36207378 PMCID: PMC9546836 DOI: 10.1038/s41598-022-21331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Sigmoid colon cancer often has an unsatisfactory prognosis. This study explored the effect of tumor deposits (TDs) on survival, and whether their presence/absence influence individualized treatment. Data of postoperative patients with sigmoid colon cancer were extracted from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) was calculated using the Kaplan-Meier method and prognostic factors were identified using Cox regression analysis and random forest (RF). The nomogram's discrimination performance was evaluated using a concordance index (C-index), integrated discrimination improvement (IDI), calibration curves, and decision-curve analysis. The N1c group showed a worse prognosis than the N0 group. For N1c patients, a combination of surgery and chemotherapy prolonged survival, compared to surgery alone; however, the chemotherapy-surgery combination did not affect the OS of patients younger than 70 years, in stage T1-2, and/or of black race. Multivariable analysis and RF presented Age, T stage, and N stage were the most important predictors for OS. The novel nomogram had superiority to the TNM staging system with improved C-index and IDI, as well as good consistency and higher clinical benefit. TDs are associated with poor survival from sigmoid colon cancer, and considering TDs can inform the formulation of individual treatment regimens. The nomogram shows satisfactory prediction ability for OS.
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Affiliation(s)
- Shan Liu
- Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou, China; College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yaobin Lin
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Sihan Huang
- Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou, China; College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shufang Xue
- Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou, China; College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Ruoyao Huang
- Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou, China; College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Lu Chen
- Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou, China; College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Department of Hematology-Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chengyi Wang
- Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou, China; College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China. .,Department of Hematology-Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Yang Y, Wang Y, Wang Z. Construction of a new clinical staging system for colorectal cancer based on the lymph node ratio: A validation study. Front Surg 2022; 9:929576. [PMID: 36090338 PMCID: PMC9452833 DOI: 10.3389/fsurg.2022.929576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Aim This study aims to construct a new staging system for colorectal cancer (CRC) based on the lymph node ratio (LNR) as a supplement to the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system for predicting the prognosis of CRC patients with <12 lymph nodes. Methods The data of 26,695 CRC patients with <12 lymph nodes were extracted from the Surveillance, Epidemiology, and End Results (SEER) database as a training set. A total of 635 CRC patients were also enrolled from Northern Jiangsu People's Hospital affiliated with Yangzhou University as an independent validation set. Classification and regression tree analysis was used to obtain the LNR cutoff value. Survival curves were estimated using the Kaplan–Meier method, and the log-rank test was used for comparisons of differences among the survival curves. The monotonic decreasing trend of the overall survival curve in the staging system was expressed by the linear correlation degree R. Results The 5-year survival rates of patients in the training set based on the AJCC staging system from stage I to stage IV were 75.6% (95%CI: 74.4–76.8), 59.8% (95%CI: 58.6–61.0), 42.1% (95%CI: 34.5–49.7), 33.2% (95%CI: 24.6–41.8), 72.0% (95%CI: 69.1–74.9), 48.8% (95%CI: 47.4–50.2), 26.5% (95%CI: 23.0–30.0), and 11.3% (95%CI: 10.3–12.3). The 5-year survival rates of patients in the training set from stage I to stage IIIC were 80.4%, 72.9%, 59.8%, 48.4%, 32.5%, and 15.0%, according to the TNM + LNR (TNRM) staging system. According to the AJCC staging system, the 5-year survival rates of patients in the validation set from stage I to stage IIIC were 91.3%, 90.8%, 72.6%, 61.3%, 72.4%, 58.1%, and 32.8%. Based on the TNRM staging system, the 5-year survival rates of patients in the validation set from stage I to stage IIIC were 99.2%, 90.5%, 81.4%, 78.6%, 60.2%, and 35.8%. Conclusion The TNRM staging system successfully eliminated “survival paradox” in the AJCC staging system, which might be superior to the AJCC staging system.
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Affiliation(s)
- Yan Yang
- Department of General Surgery, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
- Department of Gastrointestinal Surgery, Clinical Medical School, Northern Jiangsu People's Hospital affiliated to Yangzhou University, Yangzhou, China
| | - Yawei Wang
- Department of Gastrointestinal Surgery, Clinical Medical School, Northern Jiangsu People's Hospital affiliated to Yangzhou University, Yangzhou, China
- Department of General Surgery, Jiangsu Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, China
| | - Zhengbin Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Correspondence: Zhengbin Wang
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Chen J, Zhang Z, Ni J, Sun J, Ren W, Shen Y, Shi L, Xue M. Predictive and Prognostic Assessment Models for Tumor Deposit in Colorectal Cancer Patients With No Distant Metastasis. Front Oncol 2022; 12:809277. [PMID: 35251979 PMCID: PMC8888919 DOI: 10.3389/fonc.2022.809277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background More and more evidence indicated that tumor deposit (TD) was significantly associated with local recurrence, distant metastasis (DM), and poor prognosis for patients with colorectal cancer (CRC). This study aims to explore the main clinical risk factors for the presence of TD in CRC patients with no DM (CRC-NDM) and the prognostic factors for TD-positive patients after surgery. Methods The data of patients with CRC-NDM between 2010 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A logistic regression model was used to identify risk factors for TD presence. Fine and Gray’s competing-risk model was performed to analyze prognostic factors for TD-positive CRC-NDM patients. A predictive nomogram was constructed using the multivariate logistic regression model. The concordance index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and the calibration were used to evaluate the predictive nomogram. Also, a prognostic nomogram was built based on multivariate competing-risk regression. C-index, the calibration, and decision-curve analysis (DCA) were performed to validate the prognostic model. Results The predictive nomogram to predict the presence of TD had a C-index of 0.785 and AUC of 0.787 and 0.782 in the training and validation sets, respectively. From the competing-risk analysis, chemotherapy (subdistribution hazard ratio (SHR) = 0.542, p < 0.001) can significantly reduce CRC-specific death (CCSD). The prognostic nomogram for the outcome prediction in postoperative CRC-NDM patients with TD had a C-index of 0.727. The 5-year survival of CCSD was 17.16%, 36.20%, and 63.19% in low-, medium-, and high-risk subgroups, respectively (Gray’s test, p < 0.001). Conclusions We constructed an easily predictive nomogram in identifying the high-risk TD-positive CRC-NDM patients. Besides, a prognostic nomogram was built to help clinicians identify poor-outcome individuals in postoperative CRC-NDM patients with TD. For the high-risk or medium-risk subgroup, additional chemotherapy may be more advantageous for the TD-positive patients rather than radiotherapy.
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Affiliation(s)
- Jingyu Chen
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou, China
| | - Zizhen Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou, China.,Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiaojiao Ni
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou, China
| | - Jiawei Sun
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou, China.,Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Wenhao Ren
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan Shen
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Liuhong Shi
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Meng Xue
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou, China
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Wu W, Zeng S, Zhang X, Liu P, Qiu T, Li S, Gong P. The value of tumor deposits in evaluating colorectal cancer survival and metastasis: a population-based retrospective cohort study. World J Surg Oncol 2022; 20:41. [PMID: 35189906 PMCID: PMC8862372 DOI: 10.1186/s12957-022-02501-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background The role of tumor deposits (TDs) in TNM staging of colorectal cancer is controversial, especially the relationship with distant metastasis. Purpose This study aimed to determine the effect of TDs on the survival of colorectal cancer and the occurrence of distant metastasis and to determine whether TDs (+) patients behaved similarly to stage IV patients. Methods A retrospective analysis of CRC patients from two large independent cohorts from the Surveillance Epidemiology and End Results (SEER) database (n = 58775) and the First Affiliated Hospital of Dalian Medical University (n = 742). Results Univariate logistic analyses revealed that TDs are an independent predictor of liver metastasis [p < 0.001; odds ratio (OR): 5.738; 95% confidence interval (CI): 3.560–9.248] in the First Affiliated Hospital of Dalian Medical University’s patients. Meanwhile, TDs are also an independent predictor of isolated organ metastasis [p <0.001; odds ratio (OR): 3.028; 95% confidence interval (CI): 2.414–3.79; multiple organ metastases [p < 0.001; odds ratio (OR): 4.778; 95% confidence interval (CI): 4.109–5.556]; isolated liver metastasis [p < 0.001; odds ratio (OR): 4.395; 95% confidence interval (CI): 4.099–4.713] and isolated lung metastasis [p < 0.001; odds ratio (OR): 5.738; 95% confidence interval (CI): 3.560–9.248] in the SEER database. Multivariate analyses suggested TDs are an independent poor prognostic factor for distant metastasis (p <0.001). Conclusions Our results have shown that compared with patients with negative TDs, CRC patients with positive TDs are more likely to develop distant metastasis. Patients categorized as T4aN2bM0 TDs (+) and T4bN2M0 TDs (+) have a similar prognosis as those with stage IV, and hence these patients should be classified as stage IV. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02501-9.
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A comprehensive overview of tumour deposits in colorectal cancer: Towards a next TNM classification. Cancer Treat Rev 2022; 103:102325. [DOI: 10.1016/j.ctrv.2021.102325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022]
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Moon JY, Lee MR, Ha GW. Prognostic value of tumor deposits for long-term oncologic outcomes in patients with stage III colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:141-151. [PMID: 34595585 DOI: 10.1007/s00384-021-04036-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The presence of tumor deposits (TDs) in colorectal cancer is associated with a poor prognosis. In patients with the concomitant presence of both TDs and lymph nodes (LNs), there is no staging option except for the number of positive LNs alone. Therefore, to determine the prognostic value of TDs in patients with stage III colorectal cancer, meta-analyses of survival outcomes of patients with TDs were performed comparing different subgroups based on the lymph node status. METHODS PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effect models. Outcome measures were 5-year overall survival (OS) and 5-year disease-free survival (DFS). RESULTS We included in the analysis 18 nonrandomized studies and 1 prospective study that examined 90,455 patients. N1c patients (TD + LN-) had worse 5-year DFS than TDs-negative stage III patients (TD-LN +) with a RR of 1.30 (95% CI 1.06-1.61, I2 = 47%). In subgroup analysis, N1c patients had worse 5-year DFS (RR = 1.60, 95% CI = 1.25-2.05, I2 = 40%) compared with TDs-negative N1 patients (TD-N1) whereas N1c patients had better 5-year OS (RR = 0.72, 95% CI = 0.62-0.83, I2 = 0%) and 5-year DFS (RR = 0.75, 95% CI = 0.57-0.99, I2 = 0%) compared with TDs-negative N2 patients (TD-N2). CONCLUSIONS These results may suggest that current nodal staging for colorectal cancer needs modification. The presence of TDs may have more adverse oncologic outcomes than TDs-negative N1 patients. More studies are warranted to further verify these results.
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Affiliation(s)
- Jae Young Moon
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk, 561-180, South Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk, 561-180, South Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk, 561-180, South Korea.
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Pu H, Pang X, Fu J, Zheng R, Chen Y, Zhang D, Fang X. Significance of tumor deposits combined with lymph node metastasis in stage III colorectal cancer patients: a retrospective multi-center cohort study from China. Int J Colorectal Dis 2022; 37:1411-1420. [PMID: 35595975 PMCID: PMC9167180 DOI: 10.1007/s00384-022-04149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The study aimed to explore the value of tumor deposits in stage III colorectal cancer (CRC) and verify whether patients with more tumor deposit numbers have higher risk of recurrence. METHODS The retrospective cohort analysis was performed at two cancer centers of China. Stage III CRC patients who underwent radical resection at the center between April 2008 and February 2019 were identified. The Univariate/Multivariate Cox regression, Kaplan-Meier analysis, and PSM were recurrence-free survival (RFS) used. RESULTS Total 1080 stage III CRC patients (634 [58.7%] men; median [IQR] age, 60 [50-68] years) who underwent radical surgical resection were identified for inclusion in this study. Patients with tumor deposits had a 12.8% lower 3-year RFS (n = 236 [69.9%]) than the patients without tumor deposits (n = 844 [82.7%]) (P ≤ 0.0001). The 3-year RFS of patients with stage N2 (n = 335 [61.2%]) was 18.6% lower (P ≤ 0.0001) than the original cohort of patients with stage N1 (n = 745 [79.8%]), but it was similar to the RFS of patients with 4 or more tumor deposits plus lymph node metastases (n = 58 [61.4%]) (P = 0.91). The RFS for patients with 4 or more tumor deposits plus number of lymph node metastases (n = 58 [61.4%]) was 15.8% lower than the cohort of patients with 1-3 tumor deposits + number of lymph node metastases (n = 687 [77.2%]) (P = 0.001). Multivariate analysis confirmed that patients with 4 or more tumor deposits + the number of lymph node metastases (hazard ratio [HR], 1.88; 95% CI, 1.24-2.87) were independently associated with a shorter RFS. CONCLUSION The number of tumor deposits is an indicator of poor postoperative prognosis. It is necessary to incorporate the number of tumor deposits combined with the number of lymph node metastases to stratify postoperative stratification of stage III CRC, which may provide a new theoretical basis for adjuvant therapy for patients with N1 stage CRC after surgery.
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Affiliation(s)
- Hongjiang Pu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, 650118 Yunnan China ,Department of Oncology, Dazhou Central Hospital, Dazhou, 635000 Sichuan China
| | - Xiaolin Pang
- Department of Radiotherapy, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655 China
| | - Jiangping Fu
- Department of Oncology, Dazhou Central Hospital, Dazhou, 635000 Sichuan China
| | - Rui Zheng
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, 650118 Yunnan China
| | - Yaxue Chen
- Department of Nursing, Dazhou Vocational and Technical College, Dazhou, 635000 Sichuan China
| | - Dafu Zhang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, 650118 Yunnan China
| | - Xiangdong Fang
- Department of Oncology, Dazhou Central Hospital, Dazhou, 635000 Sichuan China
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Xiao S, Guo J, Zhang W, Hu X, Wang R, Chen Z, Lai C. A Six-microRNA Signature Nomogram for Preoperative Prediction of Tumor Deposits in Colorectal Cancer. Int J Gen Med 2022; 15:675-687. [PMID: 35082517 PMCID: PMC8785134 DOI: 10.2147/ijgm.s346790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Tumor deposits (TDs) are acknowledged negative prognostic factors in colorectal cancer (CRC), and their pathogenesis remains a puzzle. This study aimed to construct and validate a nomogram available for preoperative TDs prediction in CRC patients. Patients and Methods Patients from the Surveillance, Epidemiology, and End Results (SEER) and the cancer genome atlas (TCGA) databases were randomly divided into training and validation sets according to the sample size ratio of 7:3. Univariate logistic regression was performed for identifying differentially expressed microRNAs between TDs and non-TDs. Nomograms for TDs prediction were developed from the multivariate logistic regression model with least absolute shrinkage and selection operator and were validated internally in terms of accuracy, calibration, and clinical utility. Based on the target genes, pathways tightly associated with TDs were selected using enrichment analysis. Results Six clinicopathologic factors and expressions of six microRNAs (miR-614, miR-1197, miR-4770, miR-3136, miR-3173, and miR-4636) differed significantly between TDs and non-TDs CRC patients from the SEER and TCGA training sets. We compared potential prediction discrimination between two nomograms: a clinicopathologic nomogram and a six-microRNA signature nomogram. The six-microRNA signature nomogram revealed better accuracy than the clinicopathologic one for TDs prediction (AUC values of 0.96 and 0.93 in the validation cohort). The calibration plots and decision curve analysis demonstrated that the six-microRNA signature nomogram had better validity and a greater prognostic benefit versus the clinicopathologic one for TDs prediction. Calcium signaling pathways were closely associated with roles of the six microRNAs in TDs of CRC patients. Conclusion The six-microRNA signature nomogram can be used as an efficient tool for preoperative TDs prediction in CRC patients.
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Affiliation(s)
- Shihan Xiao
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Jianping Guo
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wuming Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xianqin Hu
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Ran Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Zhikang Chen
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
- Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, People’s Republic of China
- Correspondence: Zhikang Chen; Chen Lai Department of General Surgery, Xiangya Hospital, Central South University, 87th Xiangya Road, Kaifu District, Changsha, Hunan, People’s Republic of ChinaTel +86-13875982443Tel +86-13875982443 Email ;
| | - Chen Lai
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
- Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, People’s Republic of China
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