Tumor Deposits as an Adverse Prognostic Indicator in Stage III Colon Cancer: A Multicenter Database Study

Jeeyou Kim, MD; Dong Woon Lee, MD; Ji Won Park, MD, PhD; Seung-Bum Ryoo, MD, PhD; Heung-Kwon Oh, MD, PhD; Rumi Shin, MD, PhD; Jin Sun Choi, MD; Min Jung Kim, MD; Sung-Chan Park, MD; Duck-Woo Kim, MD, PhD; Seung Chul Heo, MD, PhD; Sung-Bum Kang, MD, PhD; Seung-Yong Jeong, MD, PhD; Kyu Joo Park, MD, PhD; Jae Hwan Oh, MD, PhD; On Behalf of the Seoul Colorectal Research Group (SECOG)

doi:10.1097/AS9.0000000000000456

Annals of Surgery Open (Sep 2024)

Tumor Deposits as an Adverse Prognostic Indicator in Stage III Colon Cancer: A Multicenter Database Study

Jeeyou Kim, MD,
Dong Woon Lee, MD,
Ji Won Park, MD, PhD,
Seung-Bum Ryoo, MD, PhD,
Heung-Kwon Oh, MD, PhD,
Rumi Shin, MD, PhD,
Jin Sun Choi, MD,
Min Jung Kim, MD,
Sung-Chan Park, MD,
Duck-Woo Kim, MD, PhD,
Seung Chul Heo, MD, PhD,
Sung-Bum Kang, MD, PhD,
Seung-Yong Jeong, MD, PhD,
Kyu Joo Park, MD, PhD,
Jae Hwan Oh, MD, PhD,
On Behalf of the Seoul Colorectal Research Group (SECOG)

Affiliations

Jeeyou Kim, MD: From the * Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
Dong Woon Lee, MD: † Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
Ji Won Park, MD, PhD: From the * Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
Seung-Bum Ryoo, MD, PhD: From the * Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
Heung-Kwon Oh, MD, PhD: ‖ Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Rumi Shin, MD, PhD: ¶ Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
Jin Sun Choi, MD: ¶ Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
Min Jung Kim, MD: From the * Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
Sung-Chan Park, MD: † Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
Duck-Woo Kim, MD, PhD: ‖ Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Seung Chul Heo, MD, PhD: ¶ Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
Sung-Bum Kang, MD, PhD: ‖ Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Seung-Yong Jeong, MD, PhD: From the * Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
Kyu Joo Park, MD, PhD: From the * Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
Jae Hwan Oh, MD, PhD: † Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
On Behalf of the Seoul Colorectal Research Group (SECOG)

DOI: https://doi.org/10.1097/AS9.0000000000000456
Journal volume & issue: Vol. 5, no. 3
p. e456

Abstract

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Objective:. We explored the oncological impact of tumor deposits (TDs) on colon cancer and proposed optimal modifications to the current staging system. Background:. In the existing American Joint Committee on Cancer colon cancer staging system, TDs are incorporated into the N category as N1c. When lymph node metastases (LNMs) are present, their number is considered to determine nodal stages, such as N1a/b or N2a/b, regardless of TDs. Methods:. 4212 patients with primary colon cancer who underwent surgical resection in the Seoul Colorectal Group (2010–2020) and 93,057 patients from the Surveillance, Epidemiology, and End Results*Stat database (2000–2017) were included in this study. Patients were classified according to the number of metastatic lymph nodes (LNs) (0/1–3/≥4) and the presence of TDs. Results:. TDs were significantly associated with left colon cancer, a higher T category, and vascular/perineural invasion. Patients with TDs had higher recurrence rates (23.1 vs 7.5%, P < 0.001). The TD-positive patients had notably worse overall survival (OS) and recurrence-free survival rates. The survival outcomes of TD-positive patients without LNM were inferior to those of TD-negative patients with LN1–3 (5-year OS: 78.9 vs 87.8%, P = 0.04). The survival outcomes of TD-positive patients with LN1–3 were similar to those of TD-negative patients with LN ≥4 (5-year OS: 87.0 vs 77.1%, P = 0.11). Survival outcomes obtained using the Surveillance, Epidemiology, and End Results *Stat database yielded consistent results. Conclusions:. TDs were associated with poor prognostic factors and had a significant impact on survival outcomes. The incorporation of tumor deposits into nodal classifications beyond the current N1c criteria may improve the staging system and more accurately reflect the recurrence and survival rates among patients with colon cancer. TD-positive in N1a or N1b could be categorized as N2.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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