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Impact of Tumor Deposits on Oncologic Outcomes in Stage III Colon Cancer

Wong-Chong, Nathalie, M.D.1,2; Motl, Jill, M.D.1; Hwang, Grace, M.A., M.D.1; Nassif, George J. Jr., D.O.1; Albert, Matthew R., M.D.1; Monson, John R.T., M.D., F.R.C.S. (Ire, Eng, Ed (Hon), Glas (Hon))1; Lee, Lawrence, M.D., Ph.D.1,2

doi: 10.1097/DCR.0000000000001152
Original Contributions: Colorectal Cancer
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BACKGROUND: The prognosis of tumor deposits in stage III colon adenocarcinoma is poorly described.

OBJECTIVE: The purpose of this study was to determine the impact of tumor deposits on oncologic outcomes in patients with stage III colon cancer.

DESIGN: This was a multicenter retrospective cohort study.

SETTINGS: The 2010 to 2014 National Cancer Database was queried for patients with resected stage III colon adenocarcinoma on final pathology.

PATIENTS: Patients were divided into 3 groups: lymph nodes+tumor deposits–, lymph nodes+tumor deposits+, and lymph nodes–tumor deposits+.

MAIN OUTCOME MEASURES: The main outcome was 5-year overall survival.

RESULTS: Of 74,577 patients, there were 55,800 patients with lymph nodes+tumor deposits–, 13,740 patients with lymph nodes+tumor deposits+, and 5037 patients with lymph nodes–tumor deposits+. The groups had similar patient and facility characteristics, but patients with lymph nodes+tumor deposits+ had more advanced tumor characteristics. Patients with lymph nodes–tumor deposits+ were less likely to receive adjuvant systemic therapy (52% vs 74% lymph nodes+tumor deposits– and 75% lymph nodes+tumor deposits+, p < 0.001) and had a longer delay to initiation of adjuvant treatment (>8 weeks; 43% vs 33% lymph nodes+tumor deposits– and 33% lymph nodes+tumor deposits+, p < 0.001). Patients with lymph nodes+tumor deposits+ had the lowest 5-year overall survival (46.0% vs 63.4% lymph nodes+tumor deposits– vs 61.9% lymph nodes–tumor deposits+, p < 0.001). On multivariate analysis, patients with lymph nodes–tumor deposits+ had similar 5-year overall survival compared with patients with lymph nodes+tumor deposits– with ≤3 positive lymph nodes (HR, 0.93; 95% CI, 0.87–1.01). Patients with lymph nodes+tumor deposits+ had worse prognosis regardless of the number of involved lymph nodes (≤3 +lymph nodes: HR, 1.37; 95% CI, 1.28–1.47 and ≥4 +lymph nodes: HR, 1.30; 95% CI, 1.22–1.38). Of those not receiving adjuvant treatment, patients with lymph nodes–tumor deposits+ were younger and had more adverse tumor features than lymph node+ disease. Lymph nodes–tumor deposits+ was independently associated with less delivery of adjuvant systemic therapy (OR, 0.81; 95% CI, 0.80–0.82).

LIMITATIONS: This study was limited by its retrospective analysis of a prospective database.

CONCLUSIONS: The prognosis of patients with N1c disease is similar to nodal involvement without tumor deposits, yet these patients were less likely to receive adjuvant systemic therapy. Improvement in the delivery of appropriate care in these patients may increase survival and should be a target of future quality initiatives. See Video Abstract at http://links.lww.com/DCR/A666.

1 Center for Colon and Rectal Surgery, Florida Hospital, Orlando, Florida

2 Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: None reported.

Financial Disclosures: Drs Wong-Cong, Motl, and Hwang have no conflicts of interest to declare. Drs Nassif, Albert, and Monson have received honoraria from Applied Medical for consulting. Dr Nassif has received honoraria from Mallinckrodt for speaking. Dr Albert has also received an honorarium from ConMed for consulting, stock options from Applied Medical for consulting, and honorarium from Stryker for consulting. Dr Lee has an unrestricted educational grant from Johnson & Johnson.

Podium presentation at the meeting of the American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23, 2018.

Correspondence: Lawrence Lee, M.D., Ph.D., Colon and Rectal Surgery Assistant Professor of Surgery McGill University Health Centre, 1001 Decarie Blvd, DS1-3310 Montreal, QC H4A 3J1 Canada. Twitter: @lawrenceleemd. E-mail: larry.lee@mcgill.ca.

© 2018 The American Society of Colon and Rectal Surgeons