Prognostic impact of tumor deposits in colorectal cancer

We read with great interest the article by Sun et al 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.