Comment on: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Correspondence to: Ranjith Kumaran Ramu (e-mail: ranjithkumaran2009@gmail.com)

Senior Resident

Department of General Surgery

King George’s Medical University

Uttar Pradesh

Lucknow

226003

India

BJS, https://doi.org/10.1093/bjs/znae309, published 30 December 2024

We read with interest the article by Lundström, S. et al.1, which highlights that tumour deposit count serves as an independent negative prognostic predictor for both overall survival and distant metastasis in colorectal cancer. We commend the authors for emphasizing the limitations of the current TNM staging system, which does not incorporate valuable prognostic information related to tumour deposits. We identified a few key issues that warrant further discussion.

First, as the study included patients from 2016–2019, a full five-year follow-up was unavailable for all individuals, potentially affecting long-term prognostic assessments.

Second, there appears to be heterogeneity in the treatment strategies employed across different centres. While the authors state that adjustments were made for neoadjuvant and adjuvant therapies, variations in treatment protocols among hospitals may have influenced the reported outcomes.

Third, we observed a discrepancy in the results section. Regarding Table 1, the authors state that tumour deposit-positive cases were more common in the right colon, whereas Table 1 indicates a higher prevalence in the left colon (54.8 vs. 45.1per cent).

Fourth, molecular markers such as MSI, MMR, KRAS, and BRAF were not considered, which could refine prognostic stratifications.

Lastly, there is a potential underestimate of tumour deposit numbers due to the lack of centralized pathological review of the surgical specimens. The reported prevalence of tumour deposits in this study (12 per cent) is notably lower than historical estimates (15–25 per cent), which may reflect inconsistencies in pathological assessment criteria.

We hope that our constructive suggestions will contribute to the refinement of the authors’ future research endeavours.