Abstract：Objective To analyze the predictive effect of tumor deposit(TD) on the prognosis of yp-stage Ⅲ rectal cancer patients,and its effect on postoperative adjuvant chemotherapy benefit. Methods Clinical data of 338 ypⅢ stage rectal cancer patients who received multidisciplinary treatment in Union Medical College Affiliated Hospital of Fujian Medical University from 2007 to 2017 were retrospectively analyzed. All patients were divided into the TD(-) group(n=301) and TD(+) group(n=37). Survival analysis was conducted by Kaplan-Meier method, log-rank test and univariate prognostic analysis. Multivariate prognostic analysis was performed by Cox’s regression model. Results The 5-year overall survival(OS), progress-free survival(PFS), and distant metastasis-free survival(DMFS) in the TD(-) group were significantly higher than those in the TD(+) group(59.3% vs. 42.0%,P=0.001, 79.1% vs. 55.0%,P<0.001, 55.6% vs. 38.0%,P<0.001),whereas no significant difference was observed in local recurrence-free survival(LRFS) between two groups(96.7% vs. 85.5%,P=0.679). Univariate prognostic analysis revealed that the number of TD was not correlated with the prognosis of patients(P=0.923), and postoperative adjuvant chemotherapy exerted no significant effect on the prognosis of patients in two groups(P=0.103). In multivariate analysis, TD was associated with worse OS(HR=2.343,95%CI:1.257-4.363, P=0.007). Conclusions For patients with ypⅢ stage rectal cancer undergoing multidisciplinary treatment, the prognosis of patients with TD is even worse. TD is an independent predictor for survival. No benefit can be obtained from postoperative adjuvant chemotherapy regardless of the presence or absence of TD.
Zhu Qiaoping,Li Anchuan,Xu Benhua. Predictive value of tumor deposit for the prognosis of patients with yp-stage Ⅲ rectal cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(1): 47-53.
[1] Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet, 1986, 1(8496):1479-1482. DOI:10.1016/s0140-6736(86)91510-2. [2] van Gijn W, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer:12-year follow-up of the multicentre, randomised controlled TME trial[J]. Lancet Oncol, 2011, 12(6):575-582. DOI:10.1016/S1470-2045(11)70097-3. [3] Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers:results of FFCD 9203[J]. J Clin Oncol, 2006, 24(28):4620-4625. DOI:10.1200/JCO.2006.06.7629. [4] Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon;a critical review[J]. Histopathology, 2007, 51(2):141-149. DOI:10.1111/j.1365-2559.2007.02720.x. [5] Bouquot M, Creavin B, Goasguen N, et al. Prognostic value and characteristics of N1c colorectal cancer[J]. Colorectal Dis, 2018, 20(9):248-255. DOI:10.1111/codi.14289. [6] Breugom AJ, Swets M, Bosset JF, et al. Adjuvant chemotherapy after preoperative(chemo) radiotherapy and surgery for patients with rectal cancer:a systematic review and meta-analysis of individual patient data[J]. Lancet Oncol, 2015, 16(2):200-207. DOI:10.1016/S1470-2045(14)71199-4. [7] 邓慧媛, 许泽艳, 廖承德. 直肠癌术后随访及常见并发症的影像学评估进展[J]. 肿瘤学杂志, 2019(2):158-161. DOI:10.11735/j.issn.1671-170X.2019.02. B015. Deng HY, Xu ZY, Liao CD. The progression of follow-up and imaging evaluation of common complications after rectal cancer surgery[J]. J Oncol, 2019(2):158-161. DOI:10.11735/j.issn.1671-170X.2019.02. B015. [8] Ueno H, Mochizuki H. Clinical significance of extrabowel skipped cancer infiltration in rectal cancer[J]. Surg Today, 1997, 27(7):617-622. DOI:10.1007/BF02388217. [9] Mayo E, Llanos AA, Yi X, et al. Prognostic value of tumour deposit and perineural invasion status in colorectal cancer patients:a SEER-based population study[J]. Histopathology, 2016, 69(2):230-238. DOI:10.1111/his.12936. [10] Yamano T, Semba S, Noda M, et al. Prognostic significance of classified extramural tumor deposits and extracapsular lymph node invasion in T3-4 colorectal cancer:a retrospective single-center study[J]. BMC Cancer, 2015, 15:859. DOI:10.1186/s12885-015-1885-6. [11] 解龙, 巩鹏. 结直肠癌旁肿瘤沉积的研究进展[J]. 国际外科学杂志, 2017(2):141-144. DOI:10.3760/cma.j.issn.1673-4203.2017.02.020. Xie L, Gong P. Advances in research on pericolonic tumor deposits in colorectal cancer[J]. Int J Surger, 2017(2):141-144. DOI:10.3760/cma.j.issn.1673-4203.2017.02.020. [12] Goldstein NS, Turner JR. Pericolonic tumor deposits in patients with T3N(+) MO colon adenocarcinomas:markers of reduced disease free survival and intra-abdominal metastases and their implications for TNM classification[J]. Cancer, 2000, 88(10):2228-2238. DOI:10.1002/(sici)1097-0142(20000515)88:10<2228::aid-cncr5>3.0.co;2-1. [13] Belt EJ, van Stijn MF, Bril H, et al. Lymph node negative colorectal cancers with isolated tumor deposits should be classified and treated as stage Ⅲ[J]. Ann Surg Oncol, 2010, 17(12):3203-3211. DOI:10.1245/s10434-010-1152-7. [14] Fata CR, Gonzalez RS, Liu E, et al. Mesenteric tumor deposits in midgut small intestinal neuroendocrine tumors are a stronger indicator than lymph node metastasis for liver metastasis and poor prognosis[J]. Am J Surg Pathol, 2017, 41(1):128-133. DOI:10.1097/PAS.0000000000000751. [15] Lo DS, Pollett A, Siu LL, et al. Prognostic significance of mesenteric tumor nodules in patients with stage Ⅲ colorectal cancer[J]. Cancer, 2008, 112(1):50-54. DOI:10.1002/cncr.23136. [16] Yabata E, Udagawa M, Okamoto H. Effect of tumor deposits on overall survival in colorectal cancer patients with regional lymph node metastases[J]. J Rural Med, 2014, 9(1):20-26. DOI:10.2185/jrm.2880. [17] Song YX, Gao P, Wang ZN, et al. Can the tumor deposits be counted as metastatic lymph nodes in the UICC TNM staging system for colorectal cancer[J]. PLoS One, 2012, 7(3):e34087. DOI:10.1371/journal.pone.0034087. [18] Tong LL, Gao P, Wang ZN, et al. Is the seventh edition of the UICC/AJCC TNM staging system reasonable for patients with tumor deposits in colorectal cancer[J]. Ann Surg, 2012, 255(2):208-213. DOI:10.1097/SLA.0b013e31821ad8a2. [19] Peparini N. Beyond T, N and M:the impact of tumor deposits on the staging and treatment of colorectal and gastric carcinoma[J]. Surg Oncol, 2018, 27(2):129-137. DOI:10.1016/j.suronc.2018.02.007. [20] Puppa G, Maisonneuve P, Sonzogni A, et al. Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma:relevance to prognosis and tumor staging[J]. Mod Pathol, 2007, 20(8):843-855. DOI:10.1038/modpathol.3800791. [21] Sun Z, Wang ZN, Xu YY, et al. Prognostic significance of tumor deposits in gastric cancer patients who underwent radical surgery[J]. Surgery, 2012, 151(6):871-881. DOI:10.1016/j.surg.2011.12.027. [22] Chen H, Tang Z, Chen L, et al. Evaluation of the impact of tumor deposits on prognosis in gastric cancer and a proposal for their incorporation into the AJCC staging system[J]. Eur J Surg Oncol, 2018 44(12):1990-1996. DOI:10.1016/j.ejso.2018.10.062. [23] Shang QX, Yang YS, Xu LY, et al. Prognostic significance and role in TNM stage of tumor deposits in esophageal cancer[J]. J Thorac Dis, 2017, 9(11):4461-4476. DOI:10.21037/jtd.2017.10.60. [24] Durak MG, Canda T, Yilmaz B, et al. Prognostic importance of tumor deposits in the ipsilateral axillary region of breast cancer patients[J]. Pathol Oncol Res, 2018, 25(2):577-583. DOI:10.1007/s12253-018-0515-4. [25] Wei XL, Qiu MZ, Zhou YX, et al. The clinicopathologic relevance and prognostic value of tumor deposits and the applicability of N1c category in rectal cancer with preoperative radiotherapy[J]. Oncotarget, 2016, 7(46):75094-75103. DOI:10.18632/oncotarget.12058. [26] Ueno H, Hashiguchi Y, Shimazaki H, et al. Peritumoral deposits as an adverse prognostic indicator of colorectal cancer[J]. Am J Surg, 2014, 207(1):70-77. DOI:10.1016/j.amjsurg.2013.04.009. [27] Gopal P, Lu P, Ayers GD, et al. Tumor deposits in rectal adenocarcinoma after neoadjuvant chemoradiation are associated with poor prognosis[J]. Mod Pathol, 2014, 27(9):1281-1287. DOI:10.1038/modpathol.2013.239. [28] Yagi R, Shimada Y, Kameyama H, et al. Clinical significance of extramural tumor deposits in the lateral pelvic lymph node area in low rectal cancer:a retrospective study at two institutions[J]. Ann Surg Oncol, 2016, 23(Suppl 4):552-558. DOI:10.1245/s10434-016-5379-9.
2021, Vol. 30 
