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Rethinking TNM : Tumor deposit-based prognostic models may improve N-staging in colorectal cancer

Lundström, Simon LU orcid ; Agger, Erik LU orcid ; Lydrup, Marie-Louise LU ; Jörgren, Fredrik LU and Buchwald, Pamela LU (2025) In European Journal of Surgical Oncology 51(11). p.1-9
Abstract

Introduction: Tumor deposits are an important negative prognostic factor for long-term oncological outcomes in colorectal cancer patients, independent of lymph node status. Several novel models have been proposed to further integrate tumor deposits into the TNM-staging system, but their comparative performance remains unclear. The aim of this study was to identify, compare and validate novel prognostic models incorporating tumor deposits for N-stage classification. Methods: A scoping literature review identified novel prognostic models that incorporated tumor deposits or tumor deposit count into N-staging. The identified models were validated using patient data from the Swedish Colorectal Cancer Registry, assessing overall survival,... (More)

Introduction: Tumor deposits are an important negative prognostic factor for long-term oncological outcomes in colorectal cancer patients, independent of lymph node status. Several novel models have been proposed to further integrate tumor deposits into the TNM-staging system, but their comparative performance remains unclear. The aim of this study was to identify, compare and validate novel prognostic models incorporating tumor deposits for N-stage classification. Methods: A scoping literature review identified novel prognostic models that incorporated tumor deposits or tumor deposit count into N-staging. The identified models were validated using patient data from the Swedish Colorectal Cancer Registry, assessing overall survival, distant metastasis, and local recurrence. Prognostic performance was compared to the TNM N-staging using Kaplan-Meier curves for visual analysis, Harrell's C-index for discriminative ability, and Bayesian information criterion for model fit. Results: Of 792 articles, seventeen met the inclusion criteria, resulting in ten unique models in addition to TNM. For the patient cohort, 26,970 patients remained after exclusion, of whom 3,312 (12 %) had tumor deposits. All models were superior to TNM with two models standing out; an integrated model combining lymph node and tumor deposit count, and a ratio model considering number of tumor deposits, positive lymph nodes, and total number of extracted nodal structures. All models provided prognostic value, but differences were modest. Conclusion: This study demonstrated that although all models outperformed TNM, prognostic differences between the models were small. While tumor deposits provide valuable prognostic information for high-risk patients, additional risk factors are required to further enhance the staging system.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Colorectal neoplasm, Extra nodal extension, Lymph nodes, Neoplasm staging, Prognosis
in
European Journal of Surgical Oncology
volume
51
issue
11
article number
110420
pages
1 - 9
publisher
Elsevier
external identifiers
  • scopus:105014844059
  • pmid:40916311
ISSN
0748-7983
DOI
10.1016/j.ejso.2025.110420
project
Tumor deposits – a novel approach for improved survival in colorectal cancer
Tumor deposits in rectal cancer: from diagnostics to staging and treatment
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s)
id
317a6b47-58a2-4051-bfbb-5ce7ab3da097
date added to LUP
2025-09-12 09:11:42
date last changed
2025-11-07 14:45:22
@article{317a6b47-58a2-4051-bfbb-5ce7ab3da097,
  abstract     = {{<p>Introduction: Tumor deposits are an important negative prognostic factor for long-term oncological outcomes in colorectal cancer patients, independent of lymph node status. Several novel models have been proposed to further integrate tumor deposits into the TNM-staging system, but their comparative performance remains unclear. The aim of this study was to identify, compare and validate novel prognostic models incorporating tumor deposits for N-stage classification. Methods: A scoping literature review identified novel prognostic models that incorporated tumor deposits or tumor deposit count into N-staging. The identified models were validated using patient data from the Swedish Colorectal Cancer Registry, assessing overall survival, distant metastasis, and local recurrence. Prognostic performance was compared to the TNM N-staging using Kaplan-Meier curves for visual analysis, Harrell's C-index for discriminative ability, and Bayesian information criterion for model fit. Results: Of 792 articles, seventeen met the inclusion criteria, resulting in ten unique models in addition to TNM. For the patient cohort, 26,970 patients remained after exclusion, of whom 3,312 (12 %) had tumor deposits. All models were superior to TNM with two models standing out; an integrated model combining lymph node and tumor deposit count, and a ratio model considering number of tumor deposits, positive lymph nodes, and total number of extracted nodal structures. All models provided prognostic value, but differences were modest. Conclusion: This study demonstrated that although all models outperformed TNM, prognostic differences between the models were small. While tumor deposits provide valuable prognostic information for high-risk patients, additional risk factors are required to further enhance the staging system.</p>}},
  author       = {{Lundström, Simon and Agger, Erik and Lydrup, Marie-Louise and Jörgren, Fredrik and Buchwald, Pamela}},
  issn         = {{0748-7983}},
  keywords     = {{Colorectal neoplasm; Extra nodal extension; Lymph nodes; Neoplasm staging; Prognosis}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{11}},
  pages        = {{1--9}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Rethinking TNM : Tumor deposit-based prognostic models may improve N-staging in colorectal cancer}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2025.110420}},
  doi          = {{10.1016/j.ejso.2025.110420}},
  volume       = {{51}},
  year         = {{2025}},
}