| Objective To study the relationship between tumor deposits and their numbers and the prognosis of patients with stage Ⅲ colorectal cancer.Looking for risk factors for tumor deposits.To evaluate the value of evaluating the prognosis after counting the number of tumor deposits into lymph node metastasis.Lay the foundation for further precise management and prognosis assessment for patients who are positive for tumor deposits.Methods Collection of patients with stage III colorectal cancer who underwent radical surgery at the General Hospital of Ningxia Medical University from January 1,2011 to December 31,2013.The patient’s survival time was determined by reviewing the medical records,outpatient review,or telephone return visits.Kaplan-Meier method and Log rank test were used to analyze the effect of tumor deposits and their number on the prognosis of patients with stage III colorectal cancer.Analysis of relationship between tumor deposits and clinical pathological features of patients with stage III colorectal cancer by logistic regression.Cox regression analysis was used to evaluate the prognostic value of deposits included in lymph node metastasis count.Results 1.Basic clinicopathological characteristics of patients with colorectal cancer: A total of 271 patients were included in this study,with a median age of 61 years(30~84years),colon and rectal cancer were 109 and 162.There were 36 patients lost follow-up,the5-year loss rate and the 3-year loss rate were 13.3% and 6.3%.The mean and median DFS of all patients were 55.5 months and 56.0 months,respectively.According to the presence or absence of tumor deposits,all patients were divided into the positive group of tumor deposits TD(+)and the negative group of tumor deposits TD(-).There were 91 cases in the TD(+)group and 180 cases in the TD(-)group,the positive rate of tumor deposits was 33.6%(91/271).The average DFS of TD(+)group and TD(-)group was 42.23 months and 62.03 months,and the median DFS was 26.00 months and 90.00 months,respectively.2.Analysis of prognostic factors in patients with stage III colorectal cancer:Univariate log rank test found that tumor deposits,N stage,histological grade,vascular/neural invasion,preoperative CEA and CA199 level were associated with prognosis in patients with stage III colorectal cancer,and their survival time was statistically significant(P<0.05).Cox multivariate analysis showed that tumor deposits were still independent risk factor for disease-free survival in patients with stage III colorectal cancer(P<0.05).In addition,compared with other factors(N staging,number of lymph nodes to be examined,histological grading,vascular/neurological invasion and preoperative CEA level),the relative risk of tumor deposits was higher(HR=2.102,95%CI: 1.462~3.021).3.The effect of TD and its number on the prognosis of patients with stage III CRC:The prognosis of patients in the TD(+)group was significantly worse than that in the TD(-)group(χ2=14.132,P<0.01).The median DFS of patients in the TD(+)group was significantly lower than that in the TD(-)group(26.0 vs 90.0,P<0.01).The risk of death in the TD(+)group was2.102 times that TD(-)group(95% CI: 1.462~3.021,P < 0.01).The number of tumor deposits is an independent risk factor for DFS in patients with stage III colorectal cancer who are positive for tumor deposits.The risk of death in patients with a number of tumor deposits > 2was 2.011 times than the number of tumor deposits ≤ 2(95%CI:1.169~3.458,P<0.05).4.Risk factors for tumor deposits:Univariate log rank test found that N stage and number of lymph nodes sent for examination are risk factors for tumor deposits(P<0.05).Multivariate logistic regression analysis showed that only N stage was an independent risk factor for tumor deposits(P<0.05),but there was no significant correlation between T stage,vascular/neural invasion and tumor deposits(P>0.05).5.The influence of tumor deposits and lymph node metastasis on prognosis:In patientswith lymph node metastasis,the prognosis of TD(+)group was significantly worse than the TD(-)group(P < 0.01).There was no significant difference in the prognosis between the simple tumor deposits without lymph node metastasis group and the lymph node metastasis without the tumor deposit group(P>0.05).There was no significant difference in the probability of distant metastasis between tumor deposits and lymph node metastasis(P>0.05).6.The prognostic value of tumor deposits included in the number of lymph node metastases:In the new nN stage and nTNM stage formed by counting the number of tumor deposits into lymph node metastasis,the prognosis of each period was statistically significant(P<0.05),and the difference between the survival curves of different stages was more prominent than the original N staging and the TNM stage.The new nN stage and nTNM stage were included in the COX regression multivariate analysis with tumor deposits,T stage,N stage,TNM stage,histological grade,vascular/nerve invasion,number of lymph nodes sent for examination,and preoperative CEA level,the results showed that nN stage and nTNM stage were still independent prognostic factors for CRC patients(P<0.05),while the seventh edition of N stage and TNM stage were not the independent prognostic factors(P>0.05).Conclusions 1.Tumor deposit are independent poor prognostic factors for patients with stage III colorectal cancer.Patients with more than 2 tumor deposits have a poor prognosis.2.N stage is an independent risk factor for tumor deposits,and there is no significant correlation between T stage,vascular/neural invasion and tumor deposits,suggesting that the formation of tumor deposits may be related to lymph node metastasis.3.Tumor deposits and lymph node metastasis have the same effect on the prognosis of patients with stage III colorectal cancer.The staging method of counting the number of tumor deposits into lymph node metastasis is reasonable and feasible,and is more simplified,and the value of evaluating prognosis is greater. |
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