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. 2025 Jun 23;22(13):3162-3173.
doi: 10.7150/ijms.113099. eCollection 2025.

Tumor Deposits in Non-Metastatic Colorectal Cancer as a Risk Factor of Peritoneal Metastasis

Alberto Vilar Tabanera  1 , Manuel Díez Alonso  1   2 , Yousef Allaoua  1 , Lucas Casalduero  1 , Fernando Mendoza Moreno  1 , Félix Mañes  1 , Belén Matías  1 , Lucía Diego  1 , Cristina Vera Mansilla  1 , Laura Castellá Bataller  3 , Raúl Diaz-Pedrero  2   4   5 , Miguel A Ortega  4   5 , Melchor Álvarez de Mon  4   5   6 , Alberto Gutiérrez  1   2
Affiliations

Tumor Deposits in Non-Metastatic Colorectal Cancer as a Risk Factor of Peritoneal Metastasis

Alberto Vilar Tabanera et al. Int J Med Sci. .

Abstract

Background: Although tumor deposits (TD) have been known for almost a century, their origin and mode of spread remain controversial. The main objective is to analyze the prognostic value of tumor deposits in non-metastatic colorectal cancer as a risk factor of global recurrence, locoregional recurrence, liver and lung metastasis and specially for peritoneal metastasis (PM). Methods: This study analyzed 1,425 non-metastatic colorectal cancer patients. Four groups were built, according to the presence or absence of Lymph Node Metastasis (LNM) or TD. Results: The global recurrence rate in patients with TDs was significantly higher than those without TDs (17.8% vs 60.8%; p<0.001). Patients with TDs had a lower survival and suffered higher rates of liver metastasis (8.6% vs 26.7%; p<0.001); OR of 4.244 (95% CI: 3.004-5.994) and lung metastasis (7.4% vs 19.3%; p<0.001); (OR 3.585;95% CI: 2.397-5.362). However, the main differences were found in PM (4.7 % vs 26.1 %; p<0.001); (OR: 7.511 (95% CI:5.092-11.079). Distribution by groups shows that patients with TD and LNM had a higher rate of PM. Patients with TD without any LMN had higher PM rate than those with LNM without TD. In stage III, patients with TD suffered higher rates of PM, (26.1% vs 10.9%); p< 0.001). OR: 3.075 (95% CI: 1.969-4.803). Conclusions: The presence of TD increases the risk of peritoneal metastasis. Patients with TD without LNM had higher rate of peritoneal metastasis than those with LNM without TD. TD have independent prognostic value and provide complementary information. Prognostic value of TDs is underestimated in the current TNM system.

Keywords: Tumor deposits; colorectal cancer.; peritoneal metastasis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flowchart detailing the selection of the patients in this study.
Figure 2
Figure 2
A. Panoramic view of a tumor deposit (4x). B. A focus of moderately differentiated colorectal adenocarcinoma (G2) with fibroadipose tissue infiltration (10x) is observed. C and D. At higher magnification, tubular and cribriform formations with a proliferation of atypical epithelioid cells with marked pleomorphism and numerous mitoses are identified (20x and 40x).
Figure 3
Figure 3
A. Panoramic view of a tumor deposit (4x) in relation to fibroadipose tissue without associated lymphoid tissue or infiltrated vascular or neural structures. B, C, and D. At higher magnification, a focus of well-differentiated colorectal adenocarcinoma (G1) is observed in relation to desmoplastic fibrous tissue (10x). B and C. The tumor is composed of glandular structures of different sizes with foci of intraglandular tumor necrosis (arrows) (20x and 40x). There were no statistically significant differences in the incidence of TDs by sex, age, ASA, primary tumor location, or histologic type. TDs were associated with higher T stage (0.6% in T1, 2.8% in T2, 13.6% in T3 and 30.6% in T4; p < 0.001), poorly differentiated tumors (25.7 vs. 11.2%; p < 0.001), lymphovascular infiltration (39 vs. 7.4%; p < 0.001), perineural infiltration (37.8 vs. 8.2%; p < 0.001), tumors that presented intestinal obstruction (17.9 vs. 11.8%; p = 0.041), and perforated tumors (30.3 vs. 12.5%; p < 0.001). Among the 176 tumors with TDs, 87 (49.4%) also had lymphovascular infiltration, and 76 (43.2%) also had perineural infiltration. At 60 months of follow-up, 264 patients (18.5%) died due to CRC. Cancer-related survival (CRS) at 5 years was lower in patients with TD (41.2% vs. 83.3%; p < 0.001) (OR: 4.95; 95% CI: 3.830-6.394). (Figure 4)
Figure 4
Figure 4
Kaplan-Meier estimates Cancer-related survival (CRS) by presence of Tumor Deposit.
Figure 5
Figure 5
Kaplan-Meier estimates of RFS for the entire cohort according to the presence of Tumor Deposit.
Figure 6
Figure 6
Kaplan-Meier estimates of RFS for the entire cohort according to the presence of Tumor Deposit and LNM.
Figure 7
Figure 7
Kaplan-Meier estimates of RFS for liver metastasis according to the presence of Tumor Deposit.
Figure 8
Figure 8
Kaplan-Meier estimates of RFS for liver metastasis according to the presence of Tumor Deposit and LNM.
Figure 9
Figure 9
Kaplan-Meier estimates of RFS for lung metastasis according to the presence of Tumor Deposit.
Figure 10
Figure 10
Kaplan-Meier estimates of RFS for lung metastasis according to the presence of Tumor Deposit and LNM.
Figure 11
Figure 11
Kaplan-Meier estimates of RFS for peritoneal carcinomatosis according to the presence of Tumor Deposit.
Figure 12
Figure 12
Kaplan-Meier estimates of RFS for Peritoneal metastasis according to the presence of Tumor Deposit and LNM.
See this image and copyright information in PMC

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