February's Paper of the Month cohort study aimed to investigate whether tumour deposits can help us predict the aggressiveness of an individual’s cancer.
Tumour deposit count is an independent prognostic factor in colorectal cancer-a population-based cohort study
Simon Lundström, Erik Agger, Marie-Louise Lydrup, Fredrik Jörgren, Pamela Buchwald
Br J Surg 2024 Dec 24;112(1):znae309. doi: 10.1093/bjs/znae309
What is known about the subject?
In colorectal cancer (CRC), tumor deposits (TDs) are isolated cancerous nodules in the mesentery or pericolic fat without identifiable lymph node structure. Their presence is recognized as an adverse prognostic factor, and they are included in staging systems such as TNM currently identified as N1c. However, the prognostic significance of the number of TDs remain unclear. Previous studies have indicated that patients with TDs have poorer survival outcomes, but whether an increasing number of TDs correlates with progressively worse prognosis has not been well established. There has also been debate on how TDs should be classified—whether they represent extramural vascular invasion, lymph node metastases, or a separate pathological entity.
What the study adds
This population-based cohort study by Lundström et al. provides new evidence on the prognostic impact of tumor deposit count in CRC patients. The study demonstrates that a higher number of TDs is independently associated with poorer overall survival, even after adjusting for other well-established prognostic factors such as lymph node status, extramural vascular invasion, and tumor stage. These findings support the idea that TDs are not just an incidental pathological finding but play a significant role in disease progression. The study further suggests that TD count could refine risk stratification and improve prognostic accuracy beyond current staging systems.
Implications for colorectal surgery
For colorectal surgeons, these findings highlight the importance of meticulous pathological examination of resected specimens to ensure accurate identification and quantification of TDs. As TD count appears to be an independent prognostic marker, its inclusion in staging and treatment decision-making could enhance personalized patient management. If validated in further studies, TD quantification may influence the use of adjuvant therapy, particularly in patients with node-negative disease who might still have a high risk of recurrence due to a significant TD burden. Additionally, this study reinforces the need for precise surgical techniques that achieve clear mesenteric resection margins to potentially reduce TD occurrence and improve oncological outcomes.
