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Clinical Trial
. 2021 Oct;32(10):1267-1275.
doi: 10.1016/j.annonc.2021.07.009. Epub 2021 Jul 20.

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)☆

R Cohen  1 , Q Shi  2 , J Meyers  2 , Z Jin  3 , M Svrcek  4 , C Fuchs  5 , F Couture  6 , P Kuebler  7 , K K Ciombor  8 , J Bendell  9 , A De Jesus-Acosta  10 , P Kumar  11 , D Lewis  12 , B Tan  13 , M M Bertagnolli  14 , P Philip  15 , C Blanke  16 , E M O'Reilly  17 , A Shields  15 , J A Meyerhardt  18
Affiliations
Clinical Trial

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)☆

R Cohen et al. Ann Oncol. 2021 Oct.

Abstract

Background: In colon cancer, tumor deposits (TD) are considered in assigning prognosis and staging only in the absence of lymph node metastasis (i.e. stage III pN1c tumors). We aimed to evaluate the prognostic value of the presence and the number of TD in patients with stage III, node-positive colon cancer.

Patients and methods: All participants from the CALGB/SWOG 80702 phase III trial were included in this post hoc analysis. Pathology reports were reviewed for the presence and the number of TD, lymphovascular and perineural invasion. Associations with disease-free survival (DFS) and overall survival (OS) were evaluated by multivariable Cox models adjusting for sex, treatment arm, T-stage, N-stage, lymphovascular invasion, perineural invasion and lymph node ratio.

Results: Overall, 2028 patients were included with 524 (26%) TD-positive and 1504 (74%) TD-negative tumors. Of the TD-positive patients, 80 (15.4%) were node negative (i.e. pN1c), 239 (46.1%) were pN1a/b (<4 positive lymph nodes) and 200 (38.5%) were pN2 (≥4 positive lymph nodes). The presence of TD was associated with poorer DFS [adjusted hazard ratio (aHR) = 1.63, 95% CI 1.33-1.98] and OS (aHR = 1.59, 95% CI 1.24-2.04). The negative effect of TD was observed for both pN1a/b and pN2 groups. Among TD-positive patients, the number of TD had a linear negative effect on DFS and OS. Combining TD and the number of lymph node metastases, 104 of 1470 (7.1%) pN1 patients were re-staged as pN2, with worse outcomes than patients confirmed as pN1 (3-year DFS rate: 65.4% versus 80.5%, P = 0.0003; 5-year OS rate: 87.9% versus 69.1%, P = <0.0001). DFS was not different between patients re-staged as pN2 and those initially staged as pN2 (3-year DFS rate: 65.4% versus 62.3%, P = 0.4895).

Conclusion: Combining the number of TD and the number of lymph node metastases improved the prognostication accuracy of tumor-node-metastasis (TNM) staging.

Keywords: adjuvant; colorectal cancer; prognosis; stage III; tumor deposit.

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Conflict of interest statement

Disclosure RC declares honoraria from MSD Oncology and Servier, and research grants from the ARCAD foundation, the Nuovo-Soldati foundation, the ARC foundation for cancer research and from the Servier Institute. All other authors have declared no conflicts of interest.

Figures

Figure 1:
Figure 1:
Disease-free survival and overall survival in pN1a/b, pN1c and pN2 patients according to the presence or absence of tumor deposits
Figure 2:
Figure 2:
Forest plot for the effect of tumor deposits on disease-free survival among clinical subgroups
Figure 3:
Figure 3:
Disease-free survival according to the number of tumor deposits (A) and by pN stage after adding tumor deposits to the count of positive lymph nodes (B)
See this image and copyright information in PMC

Comment in

References

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