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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Important role of tumor deposits and negative lymph nodes in prognosis of N1c colorectal cancer patients
Zhi-Gang Sun, Shao-Xuan Chen, Bai-Long Sun, Da-Kui Zhang, Ding-Rong Zhong, Tong-Yin Zhang, Yu-Wan Hu, Zi-Han Han, Wen-Xiao Wu, Zhi-Yong Hou, Li Yao, Ya-Jun Zhang, Hong-Liang Sun, Jian-Zheng Jie
Zhi-Gang Sun, Shao-Xuan Chen, Bai-Long Sun, Da-Kui Zhang, Zi-Han Han, Zhi-Yong Hou, Li Yao, Jian-Zheng Jie, Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Ding-Rong Zhong, Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
Tong-Yin Zhang, Hong-Liang Sun, Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
Yu-Wan Hu, Wen-Xiao Wu, Chinese Academy of Medical Science and Peking Union Medical College, China-Japan Friendship Hospital, Beijing 100730, China
Ya-Jun Zhang, Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
Co-first authors: Zhi-Gang Sun and Shao-Xuan Chen.
Co-corresponding authors: Hong-Liang Sun and Jian-Zheng Jie.
Author contributions: Sun ZG, Chen SX, Sun HL, Zhang YJ, Jie JZ, Zhong DR designed the research; Sun BL, Zhang DK, Han ZH, Zhang TY, Wu WX, Hou ZY, Yao L assisted in data collection; Sun HL, Hu YW, Zhang TY verified imaging data; Sun ZG, Chen SX, Sun HL, Zhang YJ, Jie JZ performed the research; All authors have read and approve the final manuscript.
Supported by the National High Level Hospital Clinical Research Funding, No. 2023-NHLHCRF-BQ-32 and No. 2023-NHLHCRF-YYPPLC-ZR-13; National Key Research and Development Program of China, No. 2024YFE0198300; and Beijing Municipal Natural Science Foundation, No. 7222316.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the China-Japan Friendship Hospital, approval No. 2024-KY-147.
Informed consent statement: The requirement to obtain the informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jian-Zheng Jie, MD, Doctor, Department of General Surgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China.
jianzhengjie@sohu.com
Received: May 23, 2025
Revised: June 26, 2025
Accepted: July 28, 2025
Published online: August 21, 2025
Processing time: 87 Days and 1.4 Hours
BACKGROUND
The number of tumor deposits (TDs) does not play a part in the current tumor node metastasis staging. Negative lymph node (NLN) status is associated with the prognosis of colorectal cancer (CRC), but its clear role in N1c stage remains to be defined.
AIM
To evaluate the combination of TDs and NLNs as potential prognostic indicators in N1c CRC.
METHODS
We retrospectively identified 107 consecutive patients who had N1c CRC radically resected at China-Japan Friendship Hospital. The combination of TDs and NLNs was calculated by the formula NLNTD = NLN/(TD + 1). Cutoff values of NLNs and NLNTD were determined using the R package “survminer”. Disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) were determined using the Kaplan-Meier method to assess the impact of NLNTD on prognosis. Results were compared using the log-rank test.
RESULTS
The median follow-up time was 63.17 (45.33-81.37) months for DFS, with 33.64% (36/107) of patients experiencing recurrence during follow-up. Five-year DFS was 66.0% (57.3%-76.0%). There was no significant difference in prognosis between patients with > 12 and ≤ 12 NLNs (P = 0.058) for DFS. Similar results were seen according to the number of TDs. The definition of NLNTD = NLN/(TD + 1) with a cutoff value of 6 divided patients into two groups with different DFS (P = 0.005). Five-year DFS for patients with NLNTD > 6 was 73.5% (63.6%-85.0%), compared with 50.0% (35.7%-70.0%) for those with NLNTD ≤ 6. These two groups had different prognosis without perineural invasion (P = 0.012) or lymphovascular invasion (P = 0.002) even neither (P = 0.053). Similar results were seen for OS and CSS.
CONCLUSION
NLNTD could serve as important prognostic factor for outcomes in N1c CRC patients. These patients could be stratified for prognosis through NLNTD and the high-risk should be given more attention during treatment.
Core Tip: To evaluate the combination of tumor deposits (TDs) and negative lymph node (NLN) as potential prognostic indicators in N1c colorectal cancer (CRC). We retrospectively identified 107 consecutive patients who had CRC with N1c disease. There was no significant difference in prognosis between patients with more than 12 NLN or not for disease free survival, the same result could be seen according to the number of TD. The definition of combination of TD and NLN (NLNTD) = NLN/(TD + 1) with cutoff value as 6 could divide patients into two groups with different prognosis for disease free survival. These two groups had different prognosis without perineural invasion or lymphovascular invasion even neither.
