Tumor Deposits in Locally Advanced Esophageal Cancer: Redefining TNM Staging and Prognostic Implications after Surgical Resection.

Background: Tumor deposits (TDs), also known as cancer nodules, were initially identified in colorectal adenocarcinoma and are defined as localized accumulations of tumor cells within the peritumoral adipose tissue. Subsequently, similar tumor nodules have also been observed in esophageal cancer(ESCA). Although evidence suggests a correlation between TDs and poor prognosis in ESCA, their qualitative, staging, and prognostic implications remain contentious. This investigation seeks to clarify the function and survival implications of TDs in ESCA.

Methods: An analysis with retrospective design was executed for 482 individuals with ESCA who received esophagectomy treatment between 2014 and 2022. Patients were categorized into the tumor deposits positive (TDP) group and the tumor deposits negative (TDN) group according to the presence or absence of TDs in postoperative specimens. The clinicopathological features of the two groups were compared, and the predictive significance of TDs underwent examination through Cox regression models, while the effect of TDs on the TNM staging framework received additional evaluation.

Results: Among the 482 patients with TNM stage III-IV ESCA, 433 (89.8%) were TDN, and 49 (10.2%) were TDP. Both in the overall cohort and within the TNM stage III and IV subgroups, the TDP group demonstrated a worse prognosis versus the TDN group. Notably, no significant prognostic difference was observed between TNM stage III TDP patients and TNM stage IV TDN patients. Within each N stage subgroup, the TDP group consistently exhibited inferior outcomes.

Conclusion: TDs are associated with poorer prognosis in ESCA and represent an independent risk factor for adverse outcomes. Subsequent updates to the TNM staging system should consider the inclusion of TDs to improve its prognostic precision.