Clinicopathological Features And Prognosis Of Colorectal Cancer With Extranodal Tumor Deposits

Objective:To discuss clinical and pathological features and prognosis of colorectal cancer with extranodal tumor deposits(ENTDs), then guide the choice of clinical treatment decisions, and further improve the prognosis of colorectal cancer with ENTDs.Methods:1. Clinicopathological data and follow-up of colorectal cancer patients with ENTDs who underwent surgery from June 2009 to June 2013 in General Surgery in the Affiliated Hospital of Qingdao University were collected retrospectively. Kaplan-Meier method was used for survival analysis and calculation, while Log-Rank test method and Cox proportional hazards model were used for univariate and multivariate analysis of prognostic factors with SPSS15.0 statistical software.2. The literatures on ENTDs and postoperative survival rate in patients with colorectal cancer published at home and abroad from 1990 to 2014 were retrieved in 15 English literature databases such as MEDLINE/Pub Med, Web of Science, Directory of Open Access Journals(DOAJ), Springer Link and Chinese literature databases such as Chinese Biomedical Literature Database CD-ROM, China National Knowledge Infrastructure(CNKI) Database.After screening for inclusion, data extraction and quality assessment, Meta-analysis was conducted by the Review Manager 5.3 software.Results:1. A total of 64 cases of colorectal cancer patients with ENTDs were collected in this study, accounting for 5.54 percent over the same period of colorectal cancer patients.The 5-year survival of colorectal cancer patients with only one ENTD was 50%(24/44),with postoperative median survival time 42.5 months. The 5-year survival of colorectal cancer patients with more than one ENTD was 22.2%(4/18), with postoperative median survival time 38.0 months. Univariate analysis showed that clinical morphology, histological type, T stage, N stage, M stage, vascular invasion, peripheral nerve infiltration, preoperative serum CEA, CA19-9, surgical approach, adjuvant treatment and the number of ENTDs were prognostic factors of colorectal cancer with ENTDs. Cox regression analysis revealed that tumor histological type, T stage and N stage were independent risk factors of prognosis of colorectal cancer with ENTDs.2. There were 10 studies meeting the inclusion criteria for Meta-analysis. The total sample size of the studies was 4068 cases with ENTD(+) 727 cases, accounting for 17.87% whileENTD(-) 3341 cases, accounting for 82.13%. Meta analysis showed that:(1) 5-year overall survival and 5-year relapse-free survival rate were significantly lower in ENTD(+) group than ENTD(-) group for patients with colorectal cancer(OR:respectively 0.27,0.23; 95%CI:respectively 0.18-0.43,0.16-0.34; both P <0.00001);(2) 5-year overall survival rates were both significantly lower in ENTD(+) group than ENTD(-) group for patients with N0 and N+ colorectal cancer(N0 group: P=0.01; N+ group: P=0.04; both P <0.05).Conclusion:1. The main gross type of colorectal cancer With ENTDs was ulcer type, while the proportion of infiltrating type was also higher; the main histological type was adenocarcinoma; differentiation degree mainly moderately and poorly differentiated; TNM staging mainly Ⅲ stage and Ⅳ stage; serum CEA and CA19-9 were increased before surgery for most patients. Clinical morphology, histological type, T stage, N stage, M stage, vascular invasion, peripheral nerve infiltration, preoperative serum CEA, CA19-9, surgical approach,adjuvant treatment and the number of ENTDs were prognostic factors of colorectal cancer with ENTDs. Tumor histological type, T stage and N stage were independent risk factors of prognosis of colorectal cancer with ENTDs.2. Extranodal tumor deposits was a poor prognostic factor in patients with colorectal cancer.The effect of extranodal tumor deposits on postoperative survival rate might resemble that of lymph node metastasis, or between lymph node metastasis and distant metastasis.