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Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area

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Abstract

Background

Although previous studies have demonstrated that tumor deposits (TDs) are associated with worse prognosis in colon cancer, their clinical significance in rectal cancer has not been fully elucidated, especially in the lateral pelvic lymph node (LPLN) area. This study aimed to clarify the clinical significance of TDs, focusing on the number of metastatic foci, including lymph node metastases (LNMs) and TDs, in the LPLN area.

Methods

This retrospective study involved 226 consecutive patients with cStage II/III low rectal cancer who underwent LPLN dissection. Metastatic foci, including LNM and TD, in the LPLN area were defined as lateral pelvic metastases (LP-M) and were evaluated according to LP-M status: presence (absence vs. presence), histopathological classification (LNM vs. TD), and number (one to three vs. four or more). We evaluated the relapse-free survival of each model and compared them using the Akaike information criterion (AIC) and Harrell’s concordance index (c-index).

Results

Forty-nine of 226 patients (22%) had LP-M, and 15 patients (7%) had TDs. The median number of LP-M per patient was one (range, 1–9). The best risk stratification power was observed for number (AIC, 758; c-index, 0.668) compared with presence (AIC, 759; c-index, 0.665) and histopathological classification (AIC, 761; c-index, 0.664). The number of LP-M was an independent prognostic factor for both relapse-free and overall survival, and was significantly associated with cumulative local recurrence.

Conclusion

The number of metastatic foci, including LNMs and TDs, in the LPLN area is useful for risk stratification of patients with low rectal cancer.

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Data availability

The datasets used in this study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank our funding agencies and all the authors involved in this study.

Funding

This research was supported by JSPS KAKENHI Grant Number JP22K08890.

Author information

Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori Chuo-Ku, Niigata City, Niigata, 951-8510, Japan

    Daisuke Yamai, Yoshifumi Shimada, Masato Nakano, Hikaru Ozeki, Akio Matsumoto, Kaoru Abe, Yosuke Tajima, Mae Nakano, Hiroshi Ichikawa, Jun Sakata & Toshifumi Wakai

  2. Center for Genomic Data Management, Niigata University Medical and Dental Hospital, Niigata City, Niigata, 951-8520, Japan

    Takahiro Nagai & Shujiro Okuda

  3. Medical AI Center, Niigata University School of Medicine, Niigata City, Niigata, 951-8514, Japan

    Yiwei Ling & Shujiro Okuda

  4. Department of Pathology, Niigata Cancer Center Hospital, Niigata City, Niigata, 951-8566, Japan

    Gen Watanabe

  5. Department of Surgery, Niigata Cancer Center Hospital, Niigata City, Niigata, 951-8566, Japan

    Hitoshi Nogami, Satoshi Maruyama & Yasumasa Takii

Authors
  1. Daisuke Yamai
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  2. Yoshifumi Shimada
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  3. Masato Nakano
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  4. Hikaru Ozeki
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  6. Kaoru Abe
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  7. Yosuke Tajima
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  8. Mae Nakano
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  9. Hiroshi Ichikawa
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  10. Jun Sakata
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  11. Takahiro Nagai
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  12. Yiwei Ling
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  13. Shujiro Okuda
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  15. Hitoshi Nogami
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  16. Satoshi Maruyama
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  17. Yasumasa Takii
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  18. Toshifumi Wakai
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Contributions

DY and YS contributed to the study conception, collection of data and drafting the article. MasN, HO, AM, KA, YoT, MaeN, HI, JS, GW, HN, SM, and YaT contributed to collection of data and interpretation of data. TN, YL, and SO contributed to analysis of data. TW contributed to interpretation of data. All authors reviewed and approved the final version of the article.

Corresponding author

Correspondence to Yoshifumi Shimada.

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Conflict of interest

None declared.

Ethics statements

This retrospective analysis was performed in accordance with the Helsinki Declaration, and the Ethics Committee of the Niigata University Medical and Dental Hospital (2018–0137) and Niigata Cancer Center Hospital (2018–34) approved the study protocol.

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Yamai, D., Shimada, Y., Nakano, M. et al. Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area. Int J Clin Oncol 28, 1388–1397 (2023). https://doi.org/10.1007/s10147-023-02391-1

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  • DOI: https://doi.org/10.1007/s10147-023-02391-1

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