结直肠癌肿瘤沉积分期争议与临床价值

Staging Controversies and Clinical Value of Tumor Deposits in Colorectal Cancer

摘要: 目的：综述结直肠癌肿瘤沉积(TD)的定义演变、TNM第9版相关争议及其临床价值。方法：检索并归纳TNM分期文件、病理报告规范、国内外指南、系统综述及相关临床研究，分析TD的病理判定、分期处理、预后意义及临床应用。结果：TD定义已由基于大小或轮廓的判断转向基于组织学本质的识别。TNM第9版强调TD与肠壁外血管侵犯、神经周围侵犯及淋巴结转移的鉴别，并建议分别记录。现有研究表明，TD的存在及其数量与复发、转移及不良生存结局相关。结论：TD是结直肠癌重要的不良病理特征，可为风险分层和临床决策提供补充信息；其判定标准及数量纳入方式仍需进一步优化。

Abstract: Objective: To review the evolving definition of tumor deposits (TD) in colorectal cancer, the controversies related to the ninth edition of the TNM staging system, and the clinical value of TD. Methods: TNM staging documents, pathology reporting standards, national and international guidelines, systematic reviews, and relevant clinical studies were reviewed to summarize the pathological identification, staging, prognostic significance, and clinical implications of TD. Results: The definition of TD has shifted from size- or contour-based rules to histology-oriented interpretation. The ninth edition of TNM emphasizes the distinction of TD from extramural vascular invasion, perineural invasion, and lymph node metastasis, and recommends separate documentation. Current evidence indicates that both the presence and number of TD are associated with recurrence, metastasis, and adverse survival outcomes. Conclusion: TD is an important adverse pathological feature in colorectal cancer and may provide additional information for risk stratification and clinical decision-making; further refinement of diagnostic criteria and incorporation of TD count into staging are still needed.