Prognostic impact of tumor deposits in colorectal cancer

We read with great interest the article by Sun <i>et al</i> addressing the prognostic role of tumor deposits (TDs) and negative lymph nodes in N1c colorectal cancer. Their proposal of the NLNTD index is a valuable step toward refining risk stratification in this subgroup. In our recently published population-based cohort of 111106 patients with early-stage colon cancer, TD positivity, classified as N1c according to AJCC definitions, was independently associated with significantly worse overall and disease-specific survival, even after propensity score matching. Taken together, these findings show that TDs are adverse prognostic factors across stages. They should inform treatment planning and follow-up, rather than be regarded as incidental.