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Rethinking TNM: Tumor deposit-based prognostic models may improve N-staging in colorectal cancer

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Titel: Rethinking TNM: Tumor deposit-based prognostic models may improve N-staging in colorectal cancer
Autoren: Lundström, Simon, Agger, Erik, Lydrup, Marie-Louise, Jörgren, Fredrik, Buchwald, Pamela
Weitere Verfasser: Lund University, Profile areas and other strong research environments, Other Strong Research Environments, LUCC: Lund University Cancer Centre, Lunds universitet, Profilområden och andra starka forskningsmiljöer, Övriga starka forskningsmiljöer, LUCC: Lunds universitets cancercentrum, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Malmö, Surgery, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Malmö, Kirurgi, Originator
Quelle: European Journal of Surgical Oncology. 51(11):1-9
Schlagwörter: Medical and Health Sciences, Clinical Medicine, Cancer and Oncology, Medicin och hälsovetenskap, Klinisk medicin, Cancer och onkologi, Surgery, Kirurgi
Beschreibung: Introduction: Tumor deposits are an important negative prognostic factor for long-term oncological outcomes in colorectal cancer patients, independent of lymph node status. Several novel models have been proposed to further integrate tumor deposits into the TNM-staging system, but their comparative performance remains unclear. The aim of this study was to identify, compare and validate novel prognostic models incorporating tumor deposits for N-stage classification. Methods: A scoping literature review identified novel prognostic models that incorporated tumor deposits or tumor deposit count into N-staging. The identified models were validated using patient data from the Swedish Colorectal Cancer Registry, assessing overall survival, distant metastasis, and local recurrence. Prognostic performance was compared to the TNM N-staging using Kaplan-Meier curves for visual analysis, Harrell's C-index for discriminative ability, and Bayesian information criterion for model fit. Results: Of 792 articles, seventeen metthe inclusion criteria, resulting in ten unique models in addition to TNM. For the patient cohort, 26,970 patients remained after exclusion, of whom 3,312 (12 %) had tumor deposits. All models were superior to TNM with two models standing out; an integrated model combining lymph node and tumor deposit count, and a ratio model considering number of tumor deposits, positive lymph nodes, and total number of extracted nodal structures. All models provided prognostic value, but differences were modest. Conclusion: This study demonstrated that although all models outperformed TNM, prognostic differences between the models were small. While tumor deposits provide valuable prognostic information for high-risk patients, additional risk factors are required to further enhance the staging system.
Zugangs-URL: https://doi.org/10.1016/j.ejso.2025.110420
Datenbank: SwePub
Beschreibung
Abstract:Introduction: Tumor deposits are an important negative prognostic factor for long-term oncological outcomes in colorectal cancer patients, independent of lymph node status. Several novel models have been proposed to further integrate tumor deposits into the TNM-staging system, but their comparative performance remains unclear. The aim of this study was to identify, compare and validate novel prognostic models incorporating tumor deposits for N-stage classification. Methods: A scoping literature review identified novel prognostic models that incorporated tumor deposits or tumor deposit count into N-staging. The identified models were validated using patient data from the Swedish Colorectal Cancer Registry, assessing overall survival, distant metastasis, and local recurrence. Prognostic performance was compared to the TNM N-staging using Kaplan-Meier curves for visual analysis, Harrell's C-index for discriminative ability, and Bayesian information criterion for model fit. Results: Of 792 articles, seventeen metthe inclusion criteria, resulting in ten unique models in addition to TNM. For the patient cohort, 26,970 patients remained after exclusion, of whom 3,312 (12 %) had tumor deposits. All models were superior to TNM with two models standing out; an integrated model combining lymph node and tumor deposit count, and a ratio model considering number of tumor deposits, positive lymph nodes, and total number of extracted nodal structures. All models provided prognostic value, but differences were modest. Conclusion: This study demonstrated that although all models outperformed TNM, prognostic differences between the models were small. While tumor deposits provide valuable prognostic information for high-risk patients, additional risk factors are required to further enhance the staging system.
ISSN:07487983
DOI:10.1016/j.ejso.2025.110420