{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:27:44Z","timestamp":1789165664038,"version":"build-2803163510"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"\n Importance<\/jats:title>\n Tumor deposits have prognostic value in colon cancer, but the current American Joint Committee on Cancer (AJCC) staging only considers them if there are no concurrent positive lymph nodes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To devise a staging system for colon cancer by integrating counts of tumor deposits with positive lymph nodes while retaining the current AJCC staging framework.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study examines data from a large-volume, tertiary care center database (January 2010 through March 2023 with follow-up until December 2023) and the population-based National Cancer Database (January 2010 through December 2020 with follow-up until December 2021). Participants were adults (age 18-75 years) with stage III colon adenocarcinoma who underwent chemotherapy, and had a specified positive lymph node count and tumor deposit count were selected.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n A real positive lymph nodes count was developed and used to derive Sassun-Mayo N\/tumor, lymph node, and metastasis (TNM) stages that were compared with the AJCC N\/TNM stages.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Receiver operating characteristic (ROC) curves and Kaplan-Meier analyses for 3-year overall survival were performed to assess the efficiency of the 2 staging systems. The concordance index was used for validation using the National Cancer Database.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From a total patient number of 11\u202f162 (institutional) and 848\u202f704 (national), the final patient numbers were 788 and 77\u202f790, respectively. The institutional database patients had a mean (SD) age of 58.5 (11.5) years; there were 433 male patients (54.9%) and 355 female (45.1%). The national database patients had a mean (SD) age of 59.3 (10.6) years; there were 40\u202f315 male patients (51.8%) and 37\u202f475 female (48.2%). ROC curve areas were improved using the Sassun-Mayo stages (3-year death for AJCC TMN, 0.63 [95% CI, 0.57-0.69] vs 0.66 [95% CI, for 0.60-0.72] for Sassun-Mayo TNM). Kaplan-Meier curves revealed visible overlaps among AJCC N stages, which were absent in the Sassun-Mayo N stages. The concordance index in the Sassun-Mayo N\/TNM stages was 0.611 and 0.616, respectively, while in the AJCC N\/TNM stages, it was 0.598 and 0.606, respectively. Patients upstaged from N1 to N2 (n\u2009=\u200910\u202f307; 13.2%) had a 3-year overall survival rate nearly identical to that of AJCC N2a patients. Additionally, 3001 patients (3.9%) were upstaged from N2a to N2b, indicating that 13\u202f308 patients (17.1%) with stage III colon cancer across cohorts were understaged.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study found that Sassun-Mayo N\/TNM staging provided superior overall survival stratification compared with the current AJCC staging, suggesting that their implementation could improve prognostication in colon cancer.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2024.6729","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T11:00:55Z","timestamp":1738753255000},"page":"408","source":"Crossref","is-referenced-by-count":24,"title":["Validated Integration of Tumor Deposits in N Staging for Prognostication in Colon Cancer"],"prefix":"10.1001","volume":"160","author":[{"given":"Richard","family":"Sassun","sequence":"first","affiliation":[{"name":"Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annaclara","family":"Sileo","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyi Cheng","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Violante","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Gomaa","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, 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