title: Is the seventh edition of the UICC/AJCC TNM staging system reasonable for patients with tumor deposits in colorectal cancer?
abstract: OBJECTIVE
  To assess the rationality of the seventh edition of TNM staging system on tumor deposits (TDs) and propose a novel subclassification.
  
  
  BACKGROUND
  The TDs had been debated for many years. The seventh edition of TNM staging system proposed a "pN1c" concept. However, the value of the modification is still debated.
  
  
  METHODS
  A total of 1541 patients with colorectal cancer were reviewed. Overall survival rates were compared between patients without LNM but TD (+), and those who were TD (-). The TDs were stratified into the "any T + any N" category. Two-step multivariate analysis was performed to identify significant prognostic factors. Univariate analysis was used to determine whether a correlation existed between the number of TDs and prognosis.
  
  
  RESULTS
  There was a significant prognostic difference between patients without LNM or TDs compared with those with positive TDs. Only in T3N2bM0 there was a significant prognostic difference between LNM (+), TD (+) patients and TD (-) patients. The seventh edition of TNM staging system was substituted by the novel TNM staging system in 2-step multivariate analysis. Only in T3N1cM0 there was a significant prognostic difference between patients with only 1 TD and those with more than 1 TD.
  
  
  CONCLUSIONS
  The seventh edition of TNM staging system on TDs satisfactorily predicts patients' outcome for those without LNM. Patients who categorized as T3N2bM0TD (+) and T4N2bM0TD (-/+) should be reclassified as stage IV. Number of TDs was not an independent prognostic parameter in the TNM staging system.
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Lin-lin
authors.initials: LL
authors.lastname: Tong
authors.forename: Peng
authors.initials: P
authors.lastname: Gao
authors.forename: Zhen-ning
authors.initials: ZN
authors.lastname: Wang
authors.forename: Yong-xi
authors.initials: YX
authors.lastname: Song
authors.forename: Ying-ying
authors.initials: YY
authors.lastname: Xu
authors.forename: Zhe
authors.initials: Z
authors.lastname: Sun
authors.forename: Cheng-zhong
authors.initials: CZ
authors.lastname: Xing
authors.forename: Hui-mian
authors.initials: HM
authors.lastname: Xu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate