TY - JOUR
T1 - Combining tumor deposits with the number of lymph node metastases to improve the prognostic accuracy in stage III colon cancer
T2 - a post hoc analysis of the CALGB/SWOG 80702 phase III study (Alliance)☆
AU - Cohen, R.
AU - Shi, Q.
AU - Meyers, J.
AU - Jin, Z.
AU - Svrcek, M.
AU - Fuchs, C.
AU - Couture, F.
AU - Kuebler, P.
AU - Ciombor, K. K.
AU - Bendell, J.
AU - De Jesus-Acosta, A.
AU - Kumar, P.
AU - Lewis, D.
AU - Tan, B.
AU - Bertagnolli, M. M.
AU - Philip, P.
AU - Blanke, C.
AU - O'Reilly, E. M.
AU - Shields, A.
AU - Meyerhardt, J. A.
N1 - Funding Information:
This work was supported by the National Cancer Institute of the National Institutes of Health [grant numbers U10CA180821 , U10CA180882 ] (to the Alliance for Clinical Trials in Oncology); [grant numbers UG1CA233163 , UG1CA233180 , UG1CA233196 , UG1CA233270 , UG1CA233290 , UG1CA233337 , UG1CA233339 , UG1CA232760 , UG1CA189858 ; U10CA180863 ] (CCTG); [grant numbers U10CA180820 , UG1CA233270 ] (ECOG-ACRIN); [grant numbers U10CA180868 ] (NRG); and [grant numbers UG1CA233163 , U10CA180888 ] (SWOG). This work was also supported in part by funds from Pfizer (no grant number). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. https://acknowledgments.alliancefound.org .
Funding Information:
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.
Publisher Copyright:
© 2021 European Society for Medical Oncology
PY - 2021/10
Y1 - 2021/10
N2 - 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.
AB - 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.
KW - adjuvant
KW - colorectal cancer
KW - prognosis
KW - stage III
KW - tumor deposit
UR - http://www.scopus.com/inward/record.url?scp=85113466043&partnerID=8YFLogxK
U2 - 10.1016/j.annonc.2021.07.009
DO - 10.1016/j.annonc.2021.07.009
M3 - Article
C2 - 34293461
AN - SCOPUS:85113466043
SN - 0923-7534
VL - 32
SP - 1267
EP - 1275
JO - Annals of Oncology
JF - Annals of Oncology
IS - 10
ER -