Prognostic value of tumor deposits in rectal cancer: A monocentric series of 505 patients. Issue 7 (12th August 2020) - Benoit, Olivier
Abstract: Background and Objectives: It has been suggested that tumor deposits (TDs) may have a worse prognosis in rectal cancer compared with colonic cancer. The aim of this study was to assess TDs prognosis in rectal cancer. Methods: Patients who underwent total mesorectum excision for rectal adenocarcinoma (2011‐2016) were included. A case‐matched analysis was performed to assess the accurate impact of TDs for each pN category after exclusion of synchronous metastasis. Results: A total of 505 patients were included. TDs were observed in 99 (19.6%) patients, (pN1c = 37 [7.3%]). TDs were associated with pT3‐T4 stage ( P = .037), synchronous metastasis ( P = .003), lymph node (LN) invasion ( P = .041), vascular invasion ( P = .001), and perineural invasion ( P < .001). TD was associated with a worse 3‐year disease‐free survival (DFS) among pN0 (51.2% vs 79.8%; P < .001); pN1 patients (35.2% vs 70.1%; P = .004) but not among pN2 patients (37.5% vs 44.7%; P = .499). After matching, pN1c patients had a worse 3‐year DFS compared with pN0 patients (58.6% vs 82.4%; P = .035) and a tendency toward a worse DFS among N1 patients (40.1% vs 64.2%; P = .153). DFS was worse when one TD was compared with one invaded LN (40.8% vs 81.3%; P < .001). Conclusion: In rectal cancer, TDs have a metastatic risk comparable to a pN2 stage which may lead to changes in adjuvant treatment.