Objective: To investigate the effect of tumor deposits (TD) on the prognosis of patients with stage III colon cancer, and to explore whether TD number included into regional lymph node count can predict the prognosis more accurately. Methods: A retrospective cohort study was carried out. Case inclusion criteria: (1) primary colon cancer; (2) undergoing colon cancer radical operation; (3) definite pathological diagnosis; (4) colon cancer stage III according to AJCC 8th edition; (5) complete follow-up data; (6) without preoperative neoadjuvant treatment. Clinicopathological data of 296 patients undergoing colon cancer radical operation from January 2005 to December 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively collected. The effect of TD and its amount on the prognosis was evaluated. Colon cancer TNM staging method based on the 8th edition of AJCC was compared with the modified TNM staging (mTNM) adjusted by the number of TD. The differences of the disease-free survival (DFS) and overall survival (OS) between groups were also examined. The Kaplan-Meier curve was used to analyze the survival, and prognostic factors were analyzed by Cox univariate and multivariate analyses. Results: Among 296 patients with stage III colon cancer, 78 patients had TD. The median number of TD was 2 (1-10). Tumor T stage, N stage, vascular tumor thrombus and preoperative carcinoembryonic antigen (CEA) were associated with TD in patients with colon cancer (all P<0.05). The right hemicolon appears likely to have TD than left hemicolon, but the difference was not statistically significant (P=0.059). The median follow-up of the whole group was 71 (6-102) months. During the follow-up period, 129 patients (43.6%) had recurrence or metastasis, and 111 patients died (37.5%). The 5-year DFS in TD group was 44.9%, which was lower than that in the non-TD group (60.6%), with statistically significant difference (P=0.003). The 5-year OS in TD group was 50.0%, which was also lower than 67.0% in the non-TD group, and the difference was statistically significant (P=0.002). According to TD number, patients were divided into 3 groups: 1 TD (25 cases), 2-3 TD (32 cases), ≥4 TD (21 cases). The 5-year DFS in these 3 groups was 68%, 56.3%, and 0, respectively (P<0.001), and 5-year OS was 76%, 59.4%, and 4.8% respectively (P<0.001). Univariate analysis showed that TD presence (95% CI: 1.234-2.694, P=0.003) and TD number (95% CI: 3.531-14.138, P<0.001) were associated with the prognosis of patients with stage III colon cancer. At the same time, age, tumor N stage, tumor location, chemotherapy, and preoperative CEA elevation were also associated with the prognosis of stage III colon cancer patients (all P<0.05). Multivariate analysis revealed that TD presence (HR=1.957, 95%CI: 1.269-3.017, P=0.002) and TD number (HR=8.020, 95% CI: 3.414-18.842, P<0.001) were still independent risk factors for the prognosis of patients with stage III colon cancer.According to the TD number counted as metastatic lymph nodes, in 78 patients with TD, 24 patients were upstaged in N stage, and 16 patients upstaged from TNM stage IIIB to stage IIIC. For 16 stage IIIB cases with staging modification, 30 unadjusted stage IIIB cases with TD, and 148 stage IIIB cases without TD, the 5-year OS was 37.5%, 73.3% and 76.4%, respectively with significant difference (P<0.001). However, for 16 patients adjusted as stage IIIC (mTNM), 32 patients with unchanged stage IIIC with TD (TNM, AJCC 8th edition), and 63 stage IIIC cases without TD, the 5-year OS was 37.5%, 36.4%, and 41.3%, respectively without significant difference (P=0.707). Conclusions: TD presence and TD number are independent risk factors for prognosis of stage III colon cancerpatients. TNM staging evaluation with lymph node number including TD number can predict the prognosis of patients more accurately.
目的： 分析癌结节数目对Ⅲ期结肠癌患者预后的影响，探讨将癌结节数目纳入区域淋巴结转移计数是否能更准确地反映患者预后。 方法： 采用回顾性队列研究方法。病例纳入标准：（1）病变原发于结肠；（2）进行结肠癌根治术；（3）病理诊断明确；（4）根据美国癌症联合委员会（AJCC）第8版结肠癌分期为Ⅲ期；（5）随访资料完整；（6）术前未接受新辅助治疗。收集2005年1月至2008年12月在中国医学科学院肿瘤医院行结肠癌根治术的296例患者临床病理资料。评估有无癌结节及其数量对这组结肠癌患者预后的影响，并对按第8版AJCC结肠癌的癌结节TNM分期方法和将癌结节数目按转移淋巴结数目调整后的TNM分期（mTNM）方法进行肿瘤分期患者的5年无病生存率（DFS）和总生存率（OS）进行比较。生存分析采用Kaplan-Meier曲线进行描述，组间比较采用log-rank检验，用Cox单因素及多因素分析结肠癌预后相关因素。 结果： 全组患者中，218例无癌结节，78例合并有癌结节，中位癌结节数为2（1~10）枚。肿瘤T分期、N分期、脉管瘤栓及术前癌胚抗原（CEA）升高与结肠癌患者有无癌结节有关，差异均有统计学意义（均P<0.05）。右半结肠较左半结肠可能更容易合并有癌结节，但差异尚无统计学意义（P=0.059）。全组患者中位随访71（6~102）个月。随访期内，129例（43.6%）复发转移，111例（37.5%）死亡。有癌结节组5年DFS为44.9%，低于无癌结节组的60.6%，差异有统计学意义（P=0.003）；有癌结节组5年OS为50.0%，也低于无癌结节组的67.0%，差异也有统计学意义（P=0.002）。将患者按癌结节数目分为1个（25例）、2~3个（32例）和4个及以上（21例）3组，其5年DFS分别为68.0%、56.3%和0，差异有统计学意义（P<0.001）；5年OS分别为76.0%、59.4%和4.8%，差异也有统计学意义（P<0.001）。单因素分析显示，癌结节有无（95%CI：1.234~2.694，P=0.003）和癌结节数目（95%CI：3.531~14.138，P<0.001）与Ⅲ期结肠癌患者预后有关，同时年龄、肿瘤N分期、肿瘤部位、是否化疗、术前CEA升高也与Ⅲ期结肠癌患者预后有关（均P<0.05）。多因素分析显示，癌结节有无（HR=1.957，95%CI：1.269~3.017，P=0.002）和癌结节数目（HR=8.020，95%CI：3.414~18.842，P=0.000）仍然是影响Ⅲ期结肠癌患者预后的独立危险因素。将癌结节数目按转移淋巴结计数，78例患者中有24例患者N分期升高，16例患者TNM综合分期由Ⅲb期升到Ⅲc期。需调整分期的16例Ⅲb期患者、30例分期未调整合并癌结节Ⅲb期患者、148例不合并有癌结节Ⅲb期患者，其5年OS分别为37.5%、73.3%和76.4%，差异有统计学意义（P<0.001）；调整分期为Ⅲc（mTNM）的16例患者、32例分期未变Ⅲc期合并癌结节患者、63例不合并有癌结节的Ⅲc期患者其5年OS分别为37.5%、36.4%、41.3%，差异无统计学意义（P=0.707）。 结论： 有无癌结节和癌结节数目是影响Ⅲ期结肠癌患者预后的独立危险因素。把癌结节数目纳入淋巴结数目整体评估决定TNM分期，更能准确地反映患者的预后。.
Keywords: Colonic neoplasms; Prognosis; Stage; Tumor deposits.