Tumor deposits in colorectal cancer: Refining their definition in the <scp>TNM</scp> system

Ueno, Hideki; Nagtegaal, Irıs D.; Quirke, Philip; Sugihara, Kenichi; Ajioka, Yoichi

doi:10.1002/ags3.12652

Cited by 15 publications

(9 citation statements)

References 43 publications

(170 reference statements)

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“…Therefore, in the aforementioned studies, the authors drew their diagnostic criteria from the definition provided by the eighth edition of the AJCC staging manual for colorectal cancer. Even in colon carcinoma, the diagnosis of TDs is subject to high interobserver variability, notably in regard to the separation of TDs from perineural/intravascular spread, the distinction from extranodal extension, and the minimal length of discontinuous spread required for diagnosis 21 . Similarly, while the eighth AJCC staging manual states that TDs should be discontinuous from the primary tumor, there is no mention of distance.…”

Section: Discussionmentioning

confidence: 99%

“…Even in colon carcinoma, the diagnosis of TDs is subject to high interobserver variability, notably in regard to the separation of TDs from perineural/intravascular spread, the distinction from extranodal extension, and the minimal length of discontinuous spread required for diagnosis. 21 Similarly, while the eighth AJCC staging manual states that TDs should be discontinuous from the primary tumor, there is no mention of distance. This is especially problematic for high-stage tumors.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma

Kmeid,

Lee,

Yang

et al. 2024

American Journal of Surgical Pathology

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The significance of discontinuous growth (DG) of the tumor to include tumor deposits and intramural metastasis in esophageal adenocarcinoma (EAC) is unclear. Esophagectomy specimens from 151 treatment-naïve and 121 treated patients with EAC were reviewed. DG was defined as discrete (≥2 mm away) tumor foci identified at the periphery of the main tumor in the submucosa, muscularis propria, and/or periadventitial tissue. Patients’ demographics, clinicopathologic parameters, and oncologic outcomes were compared between tumors with DG versus without DG. DGs were identified in 16% of treatment-naïve and 29% of treated cases (P=0.01). Age, gender, and tumor location were comparable in DG+ and DG– groups. For the treatment-naïve group, DG+ tumors were larger with higher tumor grade and stage and more frequent extranodal extension, lymphovascular/perineural invasion, and positive margin. Patients with treated tumors presented at higher disease stages with higher rates of recurrence and metastasis compared with treatment-naïve patients. In this group, DG was also associated with TNM stage and more frequent lymphovascular/perineural spread and positive margin, but not with tumor size, grade, or extranodal extension. In multivariate analysis, in all patients adjusted for tumor size, lymphovascular involvement, margin, T and N stage, metastasis, neoadjuvant therapy status, treatment year, and DG, DG was found to be an independent adverse predictor of survival outcomes in EAC. DG in EAC is associated with adverse clinicopathologic features and worse patient outcomes. DG should be considered throughout the entire clinicopathologic evaluation of treatment-naïve and treated tumors as well as in future staging systems.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma

Kmeid,

Lee,

Yang

et al. 2024

American Journal of Surgical Pathology

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“…TDs are de ned as tumor foci in the pericolic or perirectal fat, distant from the tumor invasion front, in the lymphatic drainage territory of the tumor, without recognizable residual lymph node tissue [7,10]. TDs are detected in approximately 20% of CRC, and have important prognostic impact [11,12]. In the 8th AJCC, TDs, whatever their number, are subcategorized as N1c in pathologic staging only in the absence of LNM [7].…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area

Yamai

Shimada

Nakano

et al. 2023

Preprint

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Background Although previous studies have demonstrated that tumor deposits (TDs) are associated with worse prognosis in colon cancer, their clinical significance in rectal cancer has not been fully elucidated, especially in the lateral pelvic lymph node (LPLN) area. This study aimed to clarify the clinical significance of TDs, focusing on the number of metastatic foci, including lymph node metastasis (LNM) and TD, in the LPLN area. Methods This retrospective study involved 226 consecutive patients with cStage II/III low rectal cancer who underwent LPLN dissection. Metastatic foci, including LNM and TD, in the LPLN area were defined as lateral pelvic metastasis (LP-M). LP-M was evaluated according to LP-M status: presence (absence vs presence), histopathological classification (LNM vs TD), and number (1 to 3 vs 4 or more). We evaluated the relapse-free survival of each model and compared them using the Akaike information criterion (AIC) and Harrell’s concordance index (c-index). Results Forty-nine of 226 patients (22%) had LP-M, and 15 patients (7%) had TDs. The median number of LP-M per patient was one (range, 1-9). The best risk stratification power was observed for number (AIC, 758; c-index, 0.668) compared with presence (AIC, 759; c-index, 0.665) or histopathological classification (AIC, 761; c-index, 0.664). The number of LP-M was an independent prognostic factor for both relapse-free and overall survival, and was significantly associated with cumulative local recurrence. Conclusion The number of metastatic foci, including LNM and TD, in the LPLN area is useful for risk stratification of patients with low rectal cancer.

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Section: Introductionmentioning

confidence: 99%

“…Therefore, TDs have no impact on pathological staging in the presence of LNM. Hence, the current AJCC de nition may underestimate the clinical impact of TDs in CRC [11,12]. Ueno et al stated that the potential value of an alternative staging method has been highlighted in several studies using the "counting method", in which all nodular type of TDs are individually counted together with positive LNs to derive the nal pN category, yielding a prognostic and diagnostic value that is superior to existing TNM systems [11].…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area

et al. 2023

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BackgroundAlthough previous studies have demonstrated that tumor deposits (TDs) are associated with worse prognosis in colon cancer, their clinical signi cance in rectal cancer has not been fully elucidated, especially in the lateral pelvic lymph node (LPLN) area. This study aimed to clarify the clinical signi cance of TDs, focusing on the number of metastatic foci, including lymph node metastasis (LNM) and TD, in the LPLN area. MethodsThis retrospective study involved 226 consecutive patients with cStage II/III low rectal cancer who underwent LPLN dissection. Metastatic foci, including LNM and TD, in the LPLN area were de ned as lateral pelvic metastasis (LP-M).LP-M was evaluated according to LP-M status: presence (absence vs presence), histopathological classi cation (LNM vs TD), and number (1 to 3 vs 4 or more). We evaluated the relapse-free survival of each model and compared them using the Akaike information criterion (AIC) and Harrell's concordance index (c-index). ResultsForty-nine of 226 patients (22%) had LP-M, and 15 patients (7%) had TDs. The median number of LP-M per patient was one (range, 1-9). The best risk strati cation power was observed for number (AIC, 758; c-index, 0.668) compared with presence (AIC, 759; c-index, 0.665) or histopathological classi cation (AIC, 761; 0.664). The number of LP-M was an independent prognostic factor for both relapse-free and overall survival, and was signi cantly associated with cumulative local recurrence. ConclusionThe number of metastatic foci, including LNM and TD, in the LPLN area is useful for risk strati cation of patients with low rectal cancer.

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Tumor deposits in colorectal cancer: Refining their definition in the TNM system

Cited by 15 publications

References 43 publications

Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma

Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma

Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area

Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area

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