Tumor deposit as a poor prognostic indicator in patients undergoing simultaneous resection forinitially resectable colorectal liver metastases

doi:10.3877/cma.j.issn.1674-0793.2019.04.002

Abstract

Abstract:

Objective

To determine the prognostic value of tumor deposits in initially resectable patients who underwent simultaneous resection for synchronous colorectal liver metastases (SCRLMs).

Methods

Between July 2003 and July 2015, clinicopathological and outcome data of two hundred and twelve consecutive SCRLMs patients who underwent simultaneous R0 resection were collected from SCRLMs database which was established prospectively. The prognostic value of tumor deposits was evaluated by Kaplan-Meier and Cox regression analysis.

Results

The positive rate of tumor deposits was 43.9% (93/212). Tumor deposits were significantly correlated with tumor differentiation, lymph node metastasis, vascular invasion and nerve invasion of the primary tumors (P=0.044, 0.001, 0.035, <0.001, respectively). Kaplan-Meier survival analysis revealed that the overall survival (OS) and disease-free survival (DFS) of SCRLMs patients with positive tumor deposits were significantly poorer than those with negative tumor deposits (P=0.003, <0.001, respectively). And multivariate analysis showed that positive tumor deposits were significantly associated with shorter DFS independent of lymph node status (P<0.001). Subgroup analysis found that in the 135 patients with positive lymph node status, the OS of patients with tumor deposits was not significantly different from those without tumor deposits (P=0.608); however, tumor deposits were significantly correlated with shorter DFS (P=0.003). In the 77 SCRLMs patients with negative lymph node status, tumor deposits were significantly associated with shorter OS and DFS (P<0.001, 0.010, respectively).

Conclusion

Tumor deposits may be an independent adverse prognostic factor for SCRLMs patients who underwent simultaneous R0 resection, which is significantly correlated with tumor differentiation, lymph node metastasis, vascular invasion and nerve infiltration.

Key words: Colorectal neoplasms, Tumor deposits, Neoplasm metastasis, Simultaneous resection, Prognosis

Qi Lin, Jianmin Xu. Tumor deposit as a poor prognostic indicator in patients undergoing simultaneous resection forinitially resectable colorectal liver metastases[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(04): 263-268.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2019.04.002

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2019/V13/I04/263

Figures/Tables 6

References 18

[1]	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging[J]. CA Cancer J Clin, 2017, 67(2): 93-99.
[2]	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.
[3]	Nagayoshi K, Ueki T, Nishioka Y, et al. Tumor deposit is a poor prognostic indicator for patients who have stage II and III colorectal cancer with fewer than 4 lymph node metastases but not for those with 4 or more[J]. Dis Colon Rectum, 2014, 57(4): 467-474.
[4]	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.
[5]	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.
[6]	Ueno H, Mochizuki H, Shirouzu K, et al. Multicenter study for optimal categorization of extramural tumor deposits for colorectal cancer staging[J]. Ann Surg, 2012, 255(4): 739-746.
[7]	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.
[8]	Ueno H, Mochizuki H, Shirouzu K, et al. Actual status of distribution and prognostic impact of extramural discontinuous cancer spread in colorectal cancer[J]. J Clin Oncol, 2011, 29(18): 2550-2556.
[9]	Lin Q, Wei Y, Ren L, et al. Tumor deposit is a poor prognostic indicator in patients who underwent simultaneous resection for synchronous colorectal liver metastases[J]. Onco Targets Ther, 2015, 8: 233-240.
[10]	Xu J, Qin X, Wang J, et al. Chinese guidelines for the diagnosis and comprehensive treatment of hepatic metastasis of colorectal cancer[J]. J Cancer Res Clin Oncol, 2011, 137(9): 1379-1396.
[11]	Sobin LH, Fleming ID. TNM classification of malignant tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer[J]. Cancer, 1997, 80(9): 1803-1804.
[12]	Wittekind C, Compton CC, Greene FL, et al. TNM residual tumor classification revisited[J]. Cancer, 2002, 94(9): 2511-2516.
[13]	Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol, 2010, 17(6): 1471-1474.
[14]	Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon: a critical review[J]. Histopathology, 2007, 51(2): 141-149.
[15]	Nagtegaal ID, Tot T, Jayne DG, et al. Lymph nodes, tumor deposits, and TNM: are we getting better?[J]. J Clin Oncol, 2011, 29(18): 2487-2492.
[16]	Ratto C, Ricci R, Rossi C, et al. Mesorectal microfoci adversely affect the prognosis of patients with rectal cancer[J]. Dis Colon Rectum, 2002, 45(6): 733-742.
[17]	Ishikawa K, Hashiguchi Y, Mochizuki H, et al. Extranodal cancer deposit at the primary tumor site and the number of pulmonary lesions are useful prognostic factors after surgery for colorectal lung metastases[J]. Dis Colon Rectum, 2003, 46(5): 629-636.
[18]	von Winterfeld M, Hoffmeister M, Ingold-Heppner B, et al. Frequency of therapy-relevant staging shifts in colorectal cancer through the introduction of pN1c in the 7th TNM edition[J]. Eur J Cancer, 2014, 50(17): 2958-2965.

项目		例数	癌结节阳性(93例)	癌结节阴性(119例)	χ²值	P值
年龄(岁)		?	?	?	1.367	0.242
?	≤60	132(62.3)	62(66.7)	70(58.8)	?	?
?	>60	80(37.7)	31(33.3)	49(41.2)	?	?
性别		?	?	?	0.172	0.678
?	男	122(57.5)	55(59.1)	67(56.3)	?	?
?	女	90(42.5)	38(40.9)	52(43.7)	?	?
原发灶位置		?	?	?	0.331	0.565
?	结肠	139(65.6)	59(63.4)	80(67.2)	?	?
?	直肠	73(34.4)	34(36.6)	39(32.8)	?	?
组织学类型		?	?	?	0.552	0.470
?	腺癌	178(84.0)	80(86.0)	98(82.4)	?	?
?	黏液腺癌	34(16.0)	13(14.0)	21(17.6)	?	?
肿瘤分化程度		?	?	?	4.064	0.044
?	高、中	94(44.3)	34(36.6)	60(50.4)	?	?
?	低	118(55.7)	59(63.4)	59(49.6)	?	?
T分期		?	?	?	0.265	0.606
?	T1~T2	11(5.2)	4(4.3)	7(5.9)	?	?
?	T3~T4	201(94.8)	89(95.7)	112(94.1)	?	?
淋巴结转移(N分期)		?	?	?	11.490	0.001
?	阴性	77(36.3)	22(23.7)	55(46.2)	?	?
?	阳性	135(63.7)	71(76.3)	64(53.8)	?	?
血管浸润		?	?	?	4.462	0.035
?	阴性	169(79.7)	68(73.1)	101(84.9)	?	?
?	阳性	43(20.3)	25(26.9)	18(15.1)	?	?
神经浸润		?	?	?	13.895	<0.001
?	阴性	174(82.1)	66(71.0)	108(90.8)	?	?
?	阳性	38(17.9)	27(29.0)	11(9.2)	?	?
肝转移灶(个)		?	?	?	1.234	0.267
?	≤ 3	184(86.8)	78(83.9)	106(89.1)	?	?
?	>3	28(13.2)	15(16.1)	13(10.9)	?	?
肝转移灶最大直径(cm)		?	?	?	0.000	0.999
?	< 5	155(73.1)	68(73.1)	87(73.1)	?	?
?	≥ 5	57(26.9)	25(26.9)	32(26.9)	?	?
癌胚抗原(μg/L)^a		?	?	?	0.107	0.744
?	≤5	63(31.0)	29(32.2)	34(30.1)	?	?
?	>5	140(69.0)	61(67.8)	79(69.9)	?	?

项目		例数	癌结节阳性(93例)	癌结节阴性(119例)	χ²值	P值
年龄(岁)		?	?	?	1.367	0.242
?	≤60	132(62.3)	62(66.7)	70(58.8)	?	?
?	>60	80(37.7)	31(33.3)	49(41.2)	?	?
性别		?	?	?	0.172	0.678
?	男	122(57.5)	55(59.1)	67(56.3)	?	?
?	女	90(42.5)	38(40.9)	52(43.7)	?	?
原发灶位置		?	?	?	0.331	0.565
?	结肠	139(65.6)	59(63.4)	80(67.2)	?	?
?	直肠	73(34.4)	34(36.6)	39(32.8)	?	?
组织学类型		?	?	?	0.552	0.470
?	腺癌	178(84.0)	80(86.0)	98(82.4)	?	?
?	黏液腺癌	34(16.0)	13(14.0)	21(17.6)	?	?
肿瘤分化程度		?	?	?	4.064	0.044
?	高、中	94(44.3)	34(36.6)	60(50.4)	?	?
?	低	118(55.7)	59(63.4)	59(49.6)	?	?
T分期		?	?	?	0.265	0.606
?	T1~T2	11(5.2)	4(4.3)	7(5.9)	?	?
?	T3~T4	201(94.8)	89(95.7)	112(94.1)	?	?
淋巴结转移(N分期)		?	?	?	11.490	0.001
?	阴性	77(36.3)	22(23.7)	55(46.2)	?	?
?	阳性	135(63.7)	71(76.3)	64(53.8)	?	?
血管浸润		?	?	?	4.462	0.035
?	阴性	169(79.7)	68(73.1)	101(84.9)	?	?
?	阳性	43(20.3)	25(26.9)	18(15.1)	?	?
神经浸润		?	?	?	13.895	<0.001
?	阴性	174(82.1)	66(71.0)	108(90.8)	?	?
?	阳性	38(17.9)	27(29.0)	11(9.2)	?	?
肝转移灶(个)		?	?	?	1.234	0.267
?	≤ 3	184(86.8)	78(83.9)	106(89.1)	?	?
?	>3	28(13.2)	15(16.1)	13(10.9)	?	?
肝转移灶最大直径(cm)		?	?	?	0.000	0.999
?	< 5	155(73.1)	68(73.1)	87(73.1)	?	?
?	≥ 5	57(26.9)	25(26.9)	32(26.9)	?	?
癌胚抗原(μg/L)^a		?	?	?	0.107	0.744
?	≤5	63(31.0)	29(32.2)	34(30.1)	?	?
?	>5	140(69.0)	61(67.8)	79(69.9)	?	?

预后因素	单因素分析			多因素分析
预后因素	HR	95%CI	P值	HR	95%CI	P值
年龄(>60岁：≤60岁)	0.872	0.531~1.430	0.587	?	?	?
性别(女：男)	1.284	0.790~2.087	0.313	?	?	?
肿瘤位置(直肠：结肠)	1.301	0.798~2.121	0.291	?	?	?
组织学类型(黏液腺癌：腺癌)	0.996	0.508~1.954	0.991	?	?	?
肿瘤分化(高/中：低)	1.619	0.988~2.652	0.056	?	?	?
T分期(T3~T4：T1~T2)	1.032	0.375~2.839	0.951	?	?	?
淋巴结转移(阳性：阴性)	3.333	1.778-6.247	<0.001	3.242	1.721~6.107	<0.001
血管浸润(阳性：阴性)	2.810	1.663~4.748	<0.001	2.096	1.181~3.722	0.011
神经浸润(阳性：阴性)	2.448	1.397~4.289	0.002	1.819	1.000~3.311	0.050
转移灶数(>3个：≤3个)	1.980	1.033~3.796	0.040	1.166	0.967~1.405	0.109
肝转移大小(≥5 cm：<5 cm)	1.065	0.613~1.851	0.823	?	?	?
CEA (>5 μg/L：≤5 μg/L)	1.790	1.005~3.189	0.048	1.616	0.903~2.891	0.106
癌结节(阳性：阴性)	2.041	1.250~3.332	0.004	1.495	0.879~2.542	0.138

预后因素	单因素分析			多因素分析
预后因素	HR	95%CI	P值	HR	95%CI	P值
年龄(>60岁：≤60岁)	0.872	0.531~1.430	0.587	?	?	?
性别(女：男)	1.284	0.790~2.087	0.313	?	?	?
肿瘤位置(直肠：结肠)	1.301	0.798~2.121	0.291	?	?	?
组织学类型(黏液腺癌：腺癌)	0.996	0.508~1.954	0.991	?	?	?
肿瘤分化(高/中：低)	1.619	0.988~2.652	0.056	?	?	?
T分期(T3~T4：T1~T2)	1.032	0.375~2.839	0.951	?	?	?
淋巴结转移(阳性：阴性)	3.333	1.778-6.247	<0.001	3.242	1.721~6.107	<0.001
血管浸润(阳性：阴性)	2.810	1.663~4.748	<0.001	2.096	1.181~3.722	0.011
神经浸润(阳性：阴性)	2.448	1.397~4.289	0.002	1.819	1.000~3.311	0.050
转移灶数(>3个：≤3个)	1.980	1.033~3.796	0.040	1.166	0.967~1.405	0.109
肝转移大小(≥5 cm：<5 cm)	1.065	0.613~1.851	0.823	?	?	?
CEA (>5 μg/L：≤5 μg/L)	1.790	1.005~3.189	0.048	1.616	0.903~2.891	0.106
癌结节(阳性：阴性)	2.041	1.250~3.332	0.004	1.495	0.879~2.542	0.138

预后因素	单因素分析			多因素分析
预后因素	HR	95%CI	P值	HR	95%CI	P值
年龄(>60岁：≤60岁)	0.689	0.469~1.013	0.058	?	?	?
性别(女：男)	1.139	0.790~1.644	0.486	?	?	?
肿瘤位置(直肠：结肠)	1.149	0.791~1.667	0.466	?	?	?
组织学类型(黏液腺癌：腺癌)	0.779	0.453~1.340	0.368	?	?	?
肿瘤分化(高/中：低)	1.539	1.061~2.233	0.023	?	?	?
T分期(T3~T4：T1~T2)	1.261	0.554~2.870	0.580	?	?	?
淋巴结转移(阳性：阴性)	1.789	1.195~2.678	0.005	1.469	0.972~2.220	0.068
血管浸润(阳性：阴性)	1.830	1.202~2.787	0.005	1.643	1.077~2.505	0.021
神经浸润(阳性：阴性)	1.797	1.160~2.784	0.009	1.281	0.806~2.037	0.295
转移灶数(>3个：≤3个)	2.206	1.358~3.584	0.001	2.174	1.334~3.543	0.002
肝转移大小(≥5 cm：<5 cm)	1.216	0.815~1.814	0.338	?	?	?
CEA (>5 μg/L：≤5μg/L)	1.444	0.964~2.164	0.075	?	?	?
癌结节(阳性：阴性)	2.255	1.559~3.261	<0.001	2.030	1.390~2.964	<0.001

Please choose a citation manager

Content to export