Tumor deposits counted as positive lymph nodes in TNM staging for advanced colorectal cancer: a retrospective multicenter study
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Jun Li1, Shengke Yang2, Junjie Hu3, Hao Liu4, Feng Du5, Jie Yin6, Sai Liu7, Ci Li8, Shasha Xing9, Jiatian Yuan1, Bo Lv1, Jun Fan1, Shusheng Leng1, Xin Zhang1 and Bing Wang1
1 General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China
2 General Surgery Department, Sichuan Cancer Hospital/Institution, Chengdu, People’s Republic of China
3 Gastrointestinal Tumor Surgery Department, Hubei Cancer Hospital, Wuhan, People’s Republic of China
4 General Surgery Department, 2nd Affiliated Hospital of Jilin University, Changchun, People’s Republic of China
5 Internal Medicine-Oncology, Cancer Institute/Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
6 General Surgery Department, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
7 Surgical Department of Gastrointestinal Diseases, Youan Hospital of Capital Medical University, Beijing, People’s Republic of China
8 Department of Pathology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China
9 Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People’s Republic of China
Jun Li, email:
Shengke Yang, email:
Junjie Hu, email:
Hao Liu, email:
Keywords: colorectal cancer, tumor deposits, lymph nodes
Received: October 20, 2015 Accepted: February 13, 2016 Published: February 26, 2016
We investigated the possibility of counting tumor deposits (TDs) as positive lymph nodes (pLNs) in the pN category and evaluated its prognostic value for colorectal cancer (CRC) patients. A new pN category (npN category) was calculated using the numbers of pLNs plus TDs. The npN category included 4 tiers: npN1a (1 tumor node), npN1b (2-3 tumor nodes), npN2a (4-6 tumor nodes), and npN2b (≥7 tumor nodes). We identified 4,121 locally advanced CRC patients, including 717 (11.02%) cases with TDs. Univariate and multivariate analyses were performed to evaluate the disease-free and overall survival (DFS and OS) for npN and pN categories. Multivariate analysis showed that the npN and pN categories were both independent prognostic factors for DFS (HR 1.614, 95% CI 1.541 to 1.673; HR 1.604, 95% CI 1.533 to 1.679) and OS (HR 1.633, 95% CI 1.550 to 1.720; HR 1.470, 95% CI 1.410 to 1.532). However, the npN category was superior to the pN category by Harrell’s C statistic. We conclude that it is thus feasible to consider TDs as positive lymph nodes in the pN category when evaluating the prognoses of CRC patients, and the npN category is potentially superior to the TNM (7th edition) pN category for predicting DFS and OS among advanced CRC patients.
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