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Stage III Colon Cancer Tumour Deposits Confirmed As Negative Prognostic Factor

Lymph node-positive colon cancer patients with tumour deposits have poorer survival than those without
21 Jul 2021
Colon and Rectal Cancer;  Staging Procedures (clinical staging)

Author: By Lynda Williams, Senior medwireNews Reporter 

 

medwireNews: Tumour deposits act as an independent, negative prognostic factor among stage III colon cancer patients, demonstrates a post-hoc analysis of a phase III study. 

“Given the prognostic impact of tumor deposits, we advocate for a clear, systematic and standardized description of the presence and number of tumor deposits in pathology reports”, write Romain Cohen, from Hôpital Saint-Antoine in Paris, France, and co-authors in the Annals of Oncology. 

The investigators explain that up to 20% of colon cancer patients have tumour deposits, defined as discrete tumour nodules within the lymph drainage area of the primary tumour that lack lymph node, vascular or neural structures, but that these are currently only included in the TNM staging system for node-negative patients. 

Following post-hoc analysis of the IDEA France study indicating tumour deposits may be linked to poor survival in node-positive patients, the team reviewed pathology reports for 2028 stage III colon cancer patients who participated in the CALGB/SWOG 80702 trial of chemotherapy with or without celecoxib. The researchers evaluated the presence and number of tumour deposits, as well as lymphovascular and perineural invasion. 

Overall, 524 of the patients had tumour deposits; 15.4% of these patients were node-negative (pN1c), 46.1% had fewer than four positive nodes (pN1a/b) and 38.5% at least four positive nodes (pN2). 

Patients with tumour deposits had significantly poorer disease-free survival (DFS) and overall survival (OS) than those without, with hazard ratios (HRs) of 1.63 and 1.59, respectively, after adjusting for sex, treatment, T and N stage, invasive disease and the lymph node ratio. 

The impact of tumour deposits on DFS and OS was true for both the pN1a/b and pN2 patient groups. 

Moreover, patients had a median of two tumour deposits and the number of tumour deposits had a “linear negative effect” on both survival endpoints, the researchers say. 

When patients were restaged taking into account both the number of lymph node metastases and tumour deposits, the team found that 7.1% of pN1 patients were restaged as pN2.  

Compared with confirmed pN1 patients, those restaged as pN2 had a significantly poorer 3-year rate of DFS (65.4 vs 80.5%) and 5-year rate of OS (69.1 vs 87.9%). 

By contrast, patients who were initially staged as pN2 and those who were restaged as pN2 after consideration of tumour deposits had comparable 3-year DFS (62.3 vs 65.4%) and nonsignificantly poorer 5-year OS (69.0 vs 74.0%). 

“Adding tumor deposits to the lymph node metastases count improves the prognostic accuracy of the TNM staging”, the team advises. 

“A modification of the current N classification of the AJCC/TNM staging system is warranted.” 

The researchers add: “The final missing piece of information for the implementation of tumor deposits in therapeutic decision-making related to the duration and type of adjuvant treatment is the analysis of tumor deposits in stage III colon cancer patients treated with CAPOX. 

“Unfortunately, such a post hoc analysis may not be feasible since tumor deposits are not yet routinely reported in pathological analyses”, they remark. 

 

 

Reference  

Cohen R, Shi Q, Meyers J, et al. Combining tumor deposits with the number of lymph node metastases to improve the prognostic accuracy in stage III colon cancer: a post hoc analysis of the CALGB/SWOG 80702 phase III study (Alliance). Ann Oncol; Advance online publication 19 July 2021. DOI: 10.1016/j.annonc.2021.07.009 

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare. © 2021 Springer Healthcare part of the Springer Nature group

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