Tumor deposits in stage III colon cancer: correlation with other histopatologic variables, prognostic value and risk stratification.
Victor E Pricolo1,2, *Jon Steingrimsson3, *Tracey J McDuffie1, *Joshua M. McHale1, *Brian McMillen1, *Mark Shparber1
1Southcoast Health Charlton Memorial Hospital, Fall River, MA;2Department of Medical Education, Alpert Medical School of Brown University, Providence, RI;3Brown University School of Public Health, Providence, RI
Objective: NCCN guidelines for stage III colon cancer define low-risk vs high-risk patients on the basis of T(1-3 vs 4) and N(1 vs 2), with variable duration of adjuvant chemotherapy options. This study analyzes the impact of tumor deposits (TD) and additional histopathologic features, i.e. poor differentiation (PD), perineural invasion (PNI), and lymphovascular invasion (LVI), on overall survival.
Design: Retrospective analysis of prospectively collected data. Follow-up to 80 months.
Setting:National Cancer Data Base
Patients:48,905 stage III colon cancer patients treated with surgery plus chemotherapy from 2010 to 2015.
Interventions:Data extraction on cancer program type, insurance status, Charlson-Deyo score, gender, race, age at diagnosis, histopathologic variables, survival rates. Statistical analysis with log-rank test, Kaplan-Meier curves, Cox proportional hazard regression models.
Main Outcome measures:Correlation of histopathologic variables (T and N status, TD, PD, PNI, LVI) with survival rates.
Results:Five-year survival probability was similar for LN+TD- (59.8%) and LN-TD+ patients (58.2%), but significantly worse for LN+TD+ (41.5%)(p<0.001). The presence of LN+TD+ was more often associated with PD+(37.4%), PNI+(34.5%), and LVI+(69.1%), than LN+TD- or LN-TD+(p<0.001). The hazard ratios for each adverse covariate were: T4:1.24;≥4LN+:1.22; TD+:1.25; PD+:1.43; PNI+:1.17; LVI+:1.20; for a 5-year survival of 20.1% when all present (high-risk), vs 68.9% when all absent (low-risk) (p<0.001) (figure).
LN- patients with ≥3TD+ (N1c) had worse 5-year survival (51.4%) than those with 1-2TD+ (60.6%)(p<0.01), but similar to ≥4LN+TD- (N2)(48.9%) and 1-3LN+TD+ (N1a-b)(50.7%).
Conclusions:This NCDB analysis quantifies the adverse impact of tumor deposits on prognosis for stage III colon cancer patients. Such data can refine risk stratification and may prompt reconsideration of staging, management and survivorship strategies.
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