title: Tumor Deposits in Colorectal Cancer: Improving the Value of Modern Staging-A Systematic Review and Meta-Analysis.
abstract: Purpose Colorectal cancer (CRC) treatment is largely determined by tumor stage. Despite improvements made in the treatment of various types of metastatic disease, staging has not been refined. The role of tumor deposits (TDs) in staging remains debated. We have assessed the relation of TDs with metastatic pattern to evaluate whether TDs might add significant new information to staging. Methods We performed a systematic literature search that was focused on the role of TDs in CRC. Studies with neoadjuvant-treated patients were excluded. Data on stage, histologic factors, and outcome were extracted. Data from four large cohorts were analyzed for the relevance of the presence of TDs, lymph node metastases (LNMs), and extramural vascular invasion (EMVI) on the pattern of metastases and outcomes. Results Of 10,106 included patients with CRC, 22% presented with TDs. TDs are invariably associated with poor outcome. Presence of TDs was associated with presence of LNMs and EMVI. In a pairwise comparison, effects of TD were stronger than those of both LNMs and EMVI. In the logistic regression model, TDs in combination with LNMs is the strongest predictor for liver (odds ratio [OR], 5.5), lung (OR, 4.3) and peritoneal metastases (OR, 7.0). Presence of EMVI adds information for liver and lung metastases, but not for peritoneal metastases. Conclusion We have shown that TDs are not equal to LNMs or EMVI with respect to biology and outcome. We lose valuable prognostic information by allocating TDs into nodal category N1c and only considering TDs in the absence of LNMs. Therefore, we propose that the number of TDs should be added to the number of LNMs to derive a final N stage.
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Iris D
authors.initials: ID
authors.lastname: Nagtegaal
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Nikki
authors.initials: N
authors.lastname: Knijn
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Niek
authors.initials: N
authors.lastname: Hugen
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Marshall
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Tibor
authors.initials: T
authors.lastname: Tot
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
authors.affiliation: Iris D. Nagtegaal, Nikki Knijn, and Niek Hugen, Radboud University Medical Center, Nijmegen, the Netherlands; Helen C. Marshall and Philip Quirke, Leeds University, Leeds, United Kingdom; Kenichi Sugihara, Tokyo Medical and Dental University, Tokyo; Hideki Ueno, National Defence Medical College, Tokorozawa, Japan; and Tibor Tot, Falu Lasarett, Falun, Sweden.
authors.forename: Philip
authors.initials: P
authors.lastname: Quirke
mesh_terms: D001808:Blood Vessels / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary*; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary*; D011379:Prognosis; D012307:Risk Factors