Negative prognostic impact of tumor deposits in rectal cancer – a national study cohort

Objective: To investigate whether tumor deposits (TDs) in rectal cancer are associated with
increased recurrence risk and decreased survival.
Summary background data: Tumor deposits (TDs) are considered a risk factor for
recurrence after colon cancer resection and presence of TDs prompts adjuvant chemotherapy.
The prognostic relevance of TDs in rectal cancer requires further exploration.
Methods: All patients treated with abdominal resection surgery for rectal cancer in Sweden
between 2011 and 2014 were eligible for inclusion in this retrospective cohort-study based on
prospectively collected data from the Swedish ColoRectal Cancer Registry. Primary endpoint
was local recurrence or distant metastasis. Secondary outcomes were overall and relative
survival.
Results: 5455 patients were identified. 3769 patients were analysed after exclusion. TDs were
found in 404 (10.7%) patients including where 140 (3.7%) patients with had N1c-status. In
TD-positive patients, local recurrence and distant metastasis rates at 5 years were 6.3% [95%
CI 3.8-8.8%] and 38.9% [95% CI, 33.6-43.5%] compared to 2.7% [95% CI, 2.1-3.3%] and
14.3% [95% CI, 13.1-15.5%] in TD-negative patients. In multivariable regression analysis,
risk of local recurrence and distant metastasis were increased; HR 1.86 [95% CI, 1.09-3.19;
P=0.024] and 1.87 [95% CI, 1.52-2.31; P=was 68.8% [95% CI, 64.4-73.4%] in TD-positive patients and 80.7% [95% CI, 79.4-82.1%] in
TD-negative patients. pN1c-patients had similar outcomes regarding local recurrence, distant
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metastasis and survival as pN1a-b stage patients. TD-positive pN1a-b patients had
significantly worse outcomes while TDs did not affect outcomes in pN2a-b patients.
Conclusion: This study suggests that TDs have a negative impact on prognosis in rectal
cancer. Thus, efforts should be made to diagnose TD-positive rectal cancer patients
preoperatively.