Research On Staging Method Of Tumor Deposits In Colorectal Cancer Patients

[Background & Objective]Colorectal cancer(CRC) is a most frequently cancer,that is a serious threat to human health today.It’s morbidity and mortality were ranked in third and fourth in the world,2014.As known to us, the most widely used prognostic evaluation method in clinical application of CRC is UICC/AJCC staging criteria.But some controversies still exist, the more contentious cockpit is tumor deposits(TD).TD was first described by Gabriel in 1935, and that no matter how the shape and size of the TD should be divided into the pT3, rather than positive lymph nodes,62 years latter, in the fifth revision, TD was first appeared in UICC staging in 1997.After three times of revision, our understanding of TD is continuing to improve, but there are still some controversy.The present application definition of TD is the Seventh edition AJCC/UICC stage,that" Discrete foci of tumor found in the pericolic or perirectal fat or in adjacent mesentery (mesocolic fat) away from the leading edge of the tumor and showing no evidence of residual lymph node tissue but within the lymph drainage area of the primary carcinoma are considered to be peritumoral deposits or satellite nodules, and their number should be recorded in the site-specific Prognostic Markers on the staging form as TD (TD).".This study objectived to investigate the risk factors for promoting the colorectal TD through the of clinical characteristics analysis of TD positive clinical characteristics of patients with CRC,such as age distribution sex ratio、histological differentiation et al.To discuss the relationship between TD and the prognosis of CRC, and trying to findthe relationship between TD’number and the prognosis of CRC, and evaluate its clinical significance.To evaluate the prognostic value of the new TNM staging method,that TD were counted as lymph.node metastasis (LNM).In order to improve overall survival in patients with TD colon cancer, provide a more appropriate treatment measures.[Methods]1、Consulted a lot of literature about TD to determined the integration and elimination standard.2、By retrospective survey method, collected from April 2007 to December 2009 in Yunnan province tumor hospital (the third affiliated hospital, kunming medical university) Clinical Research Center of CRC were confirmed by pathology for CRC, and through the radical surgical treatment CRC patients’survival data and clinical data, determined by patients hospitalized patients with follow-up or telephone follow-up to determined patients’ overall survival.3、Data arrangement and Statistical analysis,(1) Objective To analyze the clinic data of CRC patients through single factor and multiple factors data analysis, to explore the basic clinical data relations with TD.(2) Analysis the TD’s relationship with the prognosis of CRC patients.(3) The prognosis impact of TD status were analysed in CRC patients with LNM.(4) Analysis the relationship between TD’number and the prognosis of CRC patients,trying to find the new staging method of TD.(5) To evaluate the prognostic value of the new TNM staging method,that TD were counted as LNM.[Result]1、We put the patients’ age,gender, pathological type, pathological stage,tumor size,tumor location,histological differentiation,lymph node number,detection,neural vascular invasion,CEA,T stage,N stage,M stage were into univariate and multivariate analysis, showed that high N staging and preoperative CEA level is a risk factor for the existence of cancer TD.2、Prognosis:the prognosis of TD positive was significantly lower than the group tumor nodules negative(P<0.05);The prognosis of no LNM only TD positive group was significantly worse than the group that only LNM without TD(P<0.05). Univariate and multivariate analysis showed that TD,vascular/nerve invasion,postoperative adjuvant chemotherapy, CEA is an independent prognostic factor for overall survival in patients with CRC (P< 0.05), cancer prognosis after chemotherapy in patients with TD positive was significantly better than those not treated with chemotherapy, but still significant difference in the patients without TD and postoperative adjuvant chemotherapy (74.8%vs52.7%, P=0.024).3、The prognosis of patients with LNM in TD positive group were significantly worse than patients without TD (51.3%vs74.9%, P=0.007). Put TD, nerve/vascular invasion, postoperative adjuvant therapy, TNM staging, M staging, N staging data into multivariate Cox regression model analysis, found the TD, postoperative adjuvant chemotherapy is the independent risk factors for overall survival in LNM patients with CRC (P< 0.05),there was significant prognostic difference between TNM stage Ⅳ and ⅢA(P<0.05).4、We will be in accordance in the patients with TD were divided into two groups by the number of TD while 1,2,3 as the critical value,and the prognosis was compared between the two groups, the results shows that only the group divided by TD=1 has significant difference in prognosis (31.2%vs61%, P=0.018), no significant difference in TD=2 and TD=3 group(P>0.05).5、The TD were included in the new nN staging and TNM staging,that counted as lymph nodes metastasis have significant differences in the prognosis of every stage(P<0.05). Multivariate analysis showed that TNM stage (nN) is still prognosis factors, the seventh edition of TNM staging, but not.[Conclution]1、The existence of the TD associated with tumor invasive growth, higher N staging and preoperative CEA level is a risk factor for the existence of TD.2、TD is an independent adverse prognosis factors in patients with CRC, so as lymph nodes metastasis patients, perhaps we should strengthen postoperative adjuvant chemotherapy in patients with TD3、The number of TD have certain relevance with the prognosis of patients with CRC.4、The value assessment patients’prognosis of TNM staging that counted TD as lymph nodes metastasisis is better than seven edition of TNM staging system, and the TNM staging system is simplified.