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• W2896584341 abstract "Tumor deposits (TDs) are associated with poor prognosis in colorectal cancer. However, the significance in locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (neo-CRT) and surgery is unclear. We aimed to evaluate the prognostic significance of TDs in LARC patients after neo-CRT, to verify the applicability of the N1c category, and to explore the appropriate methods of N staging in those patients. Between 2006 and 2014, 495 LARC patients following neo-CRT and surgery were retrospectively analyzed. Clinicopathological features, overall survival (OS), disease-free survival (DFS), distant metastasis free survival (DMFS) and local recurrence free survival (LRFS) were recorded. Univariate and multivariate analysis were performed using the Kaplan-Meier method and the Cox proportional hazards regression in all patients and lymph nodes negative patients, respectively. In addition, we use three methods of N categories to evaluate the impacts of the counts of TDs on staging (1) oN, N staging without TDs; (2) n1N, N staging according to the N1c category of the 8th edition AJCC staging system; and (3) n2N, N staging including the counts of TDs, considering one TD as one positive lymph node. Of the 495 patients, TDs were found in 88 (17.8%) cases. TDs positive patients were associated with poorer tumor differentiation, worse tumor regression, positive vascular or neural invasion, more advanced cN, ypT, and ypN categories. Kaplan-Meier method and univariate analysis showed that TDs positive patients had worse OS, DFS, and DMFS compared with TDs negative patients, both in all patients and lymph nodes negative patients (all P < 0.01). In multivariate analysis, TD was an independent poor prognostic factor of OS (HR 1.774, 95% CI 1.124-2.800, P = 0.014), DFS (HR 1.638, 95% CI 1.135-2.363, P = 0.008), and LRFS (HR 2.072, 95% CI 1.040-4.127, P = 0.038) in all patients, but not DMFS (HR 1.433, 95% CI 0.939-2.187, P = 0.095). In addition, in lymph nodes negative patients, TD was also an independent poor prognostic factor of OS (HR 2.522, 95% CI 1.267-5.021, P = 0.008), DFS (HR 2.463, 95% CI 1.472-4.121, P = 0.001), and DMFS (HR 2.338, 95% CI 1.286-4.251, P = 0.005), but not LRFS (HR 2.109, 95% CI 0.701-6.343, P = 0.184). Then three separate multivariate analyses showed that oN was not an independent prognostic factor, but n1N and n2N were independent poor prognostic factors of OS (n1N, P = 0.003; n2N, P = 0.003), DFS (n1N, P = 0.001; n2N, P = 0.001) and DMFS (n1N, P < 0.001; n2N, P < 0.001), but not LRFS (n1N, P = 0.202; n2N, P = 0.079). There were no differences in survival between TD(+)LN(-) and LN(+)TD(-) patients with the same counts of TDs and positive lymph nodes (all P > 0.1). TD is an independent poor prognostic factor and has adverse impact on staging in LARC patients following neo-CRT and surgery. The N1c category is also applicable in lymph nodes negative patients. It needs further studies to investigate whether one positive TD could be considered as one positive lymph node." @default.
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• W2896584341 date "2018-11-01" @default.
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• W2896584341 title "Poor Prognostic and Staging Value of Tumor Deposits in Locally Advanced Rectal Cancer with Neoadjuvant Chemoradiotherapy" @default.
• W2896584341 doi "https://doi.org/10.1016/j.ijrobp.2018.07.240" @default.
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