A high number of tumor deposits (≥ 4) is an isolated predictor of local recurrence and distant metastasis in non-metastatic colorectal cancer: a single center study

Abstract Introduction Local recurrence and distant metastasis after curative surgery and chemotherapy for colorectal cancer (CRC) is a serious complication and is considered a failure of the therapeutic strategy. The aim of this study is to identify the different prognostic factors associated with tumor recurrence and distant metastasis in CRC. Design An analytical cross-sectional design was employed, and our hospital clinical and pathology databases were queried for non-metastatic CRC (stage I-III). Patients were included if they underwent surgery and chemotherapy between 01/2016 to 12/2018 and demographic information, tumor characteristics and postoperative outcomes were extracted from each case. The data were entered into a database using SPSS version 21. Univariate analysis was initially performed, followed by a multivariate analysis to develop a prognostic model for tumor recurrence and distant metastasis in CRC. Result A total of 138 non-metastatic CRC patients were enrolled in this study. The demographic characteristics of all patients are summarized in Table 1. Our study included 65 male and 73 female patients with a Median (IQR) age of 69 (17.7) years. Among the cases, 91 (65.9%) patients had no recurrence, and 47 (34.1%) patients developed a recurrence during follow-up. Univariate analysis revealed that positive lymph nodes ( p = 0.03) and tumor deposits ≥ 4 ( p = 0.04) were significantly associated with colorectal tumor recurrence and/or metastasis. However, variables such as age, sex, smoking, alcohol consumption, family history of CRC, PNI, LVI, tumor size, and histological features like mucinous or signet ring cell morphology did not show any statistical significance ( p > 0.05). Multivariate analysis adjusted for age, lymph node status, and tumor deposits, identified that tumor deposits ≥ 4 was the only predictor of tumor recurrence following colorectal surgery and chemotherapy. Conversely, positive lymph node status did not show statistical significance ( p = 0.3). Further analysis revealed that patients who had tumor deposit number ≥ 4 tend to experience local recurrence/distant metastasis more than patients with tumor deposit number < 4. Conclusion In non-metastatic CRC patients, TD ≥ 4 is a strong predictor of local tumor recurrence and distant metastasis. Based on these findings, patients who have TDs in primary CRC resection should be subjected to enhanced surveillance.