Tumor Deposits Should Not Be Ignored in the AJCC TNM Staging System for ypN(+) Stage Rectal Cancer with Neoadjuvant Chem
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RESEARCH COMMUNICATION
Tumor Deposits Should Not Be Ignored in the AJCC TNM Staging System for ypN(+) Stage Rectal Cancer with Neoadjuvant Chemoradiotherapy Liang Yu 1,2 & Tianlei Xu 1,2 & Lin Zhang 1,2 & Yuelu Zhu 3 & Hui Fang 4 & Haizeng Zhang 1,2,5 Received: 11 April 2020 / Accepted: 25 May 2020 # 2020 The Society for Surgery of the Alimentary Tract
Introduction
Results
In the current American Joint Committee on Cancer (AJCC) TNM staging system, tumor deposits (TDs) are classified as stage N1c when lacking lymph node metastases (LNM) for patients with rectal cancer.1 Whether this stratification method is suitable for patients treated with neoadjuvant chemoradiotherapy (NCRT) is still unknown.2–4 Thus, we conducted this retrospective study to assess the prognostic value of TDs in patients with rectal cancer after NCRT.
The patients’ clinicopathological characteristics are summarized in Table 1. TDs were identified in 44 patients; 25 patients had both TDs and LNM, while 19 patients had only TDs. For the entire cohort, the 3-year disease-free survival (DFS) was significantly lower in patients with TDs than in those without TDs (47.0% vs 78.8%, P < 0.001; Fig. 1a). In patients without LNM, those with TDs (stage ypN1c) had a significantly lower 3-year DFS than stage ypN0 patients (54.2% vs 88.2%, P = 0.002; Fig. 1b). We stratified 184 LNM(+) patients into two groups according to the presence or absence of TDs. A significant difference in prognosis was observed between the LNM(+)TD(+) and LNM(+)TD(−) groups: the LNM(+)TD(+) patients had significantly lower 3-year DFS (42.2% vs 59.3%, P = 0.036; Fig. 1c). We further investigated the prognostic value of TDs in LNM(+) patients according to the ypN stage. No significant difference in 3-year DFS was found among stages ypN1a, ypN1b, and ypN1c (65.6% vs 57.2% vs 54.2%, P = 0.86, Fig. 1d). For stage ypN1a and ypN1b patients, there was a tendency for ypN1a-bTD(+) patients to have a lower 3-year DFS than ypN1a-bTD(−) patients, but the difference was not
Methods A retrospective cohort including 530 consecutive patients with rectal cancer who received NCRT and radical surgery at the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences (CICAMS) between January 2004 and December 2016 was enrolled in the study. This study was approved by the institutional review board of CICAMS.
* Haizeng Zhang [email protected] 1
2
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China State Key Lab of Molecular Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
3
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
4
Depart
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