{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:18:32Z","timestamp":1790007512858,"version":"4.0.1"},"reference-count":44,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Swedish Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ejso.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.ejso.2025.110420","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T06:59:46Z","timestamp":1756450786000},"page":"110420","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["Rethinking TNM: Tumor deposit-based prognostic models may improve N-staging in colorectal cancer"],"prefix":"10.1016","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-7128","authenticated-orcid":false,"given":"Simon","family":"Lundstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4463-2336","authenticated-orcid":false,"given":"Erik","family":"Agger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4803-8548","authenticated-orcid":false,"given":"Marie-Louise","family":"Lydrup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3876-4033","authenticated-orcid":false,"given":"Fredrik","family":"J\u00f6rgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6407-5552","authenticated-orcid":false,"given":"Pamela","family":"Buchwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ejso.2025.110420_bib1","series-title":"TNM classification of malignant tumours (8th edn","author":"Brierley","year":"2017"},{"key":"10.1016\/j.ejso.2025.110420_bib2","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1136\/gutjnl-2022-327736","article-title":"Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN","volume":"72","author":"Eileen","year":"2023","journal-title":"Gut"},{"key":"10.1016\/j.ejso.2025.110420_bib3","series-title":"TNM classification of malignant tumours (7th edn","author":"Sobin","year":"2009"},{"key":"10.1016\/j.ejso.2025.110420_bib4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s00384-023-04365-1","article-title":"Adverse impact of tumor deposits in lymph node negative rectal cancer - a national cohort study","volume":"38","author":"Lundstr\u00f6m","year":"2023","journal-title":"Int J Colorectal Dis"},{"key":"10.1016\/j.ejso.2025.110420_bib5","doi-asserted-by":"crossref","first-page":"e526","DOI":"10.1097\/SLA.0000000000005755","article-title":"Negative prognostic impact of tumor deposits in rectal cancer: a national study cohort","volume":"278","author":"Agger","year":"2023","journal-title":"Ann Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib6","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zrad122","article-title":"Tumour deposits in Colon cancer predict recurrence and reduced survival in a nationwide population-based study","volume":"7","author":"J\u00f6rgren","year":"2023","journal-title":"BJS Open"},{"key":"10.1016\/j.ejso.2025.110420_bib7","doi-asserted-by":"crossref","DOI":"10.1093\/bjs\/znae309","article-title":"Tumour deposit count is an independent prognostic factor in colorectal cancer\u2014a population-based cohort study","volume":"112","author":"Lundstr\u00f6m","year":"2024","journal-title":"Br J Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib8","doi-asserted-by":"crossref","DOI":"10.1007\/s00384-021-04036-z","article-title":"Prognostic value of tumor deposits for long-term oncologic outcomes in patients with stage III colorectal cancer: a systematic review and meta-analysis","volume":"37","author":"Moon","year":"2022","journal-title":"Int J Colorectal Dis"},{"key":"10.1016\/j.ejso.2025.110420_bib9","doi-asserted-by":"crossref","DOI":"10.1016\/j.annonc.2021.08.1751","article-title":"Tumor deposits improve staging in colon cancer: what are the next steps?","volume":"32","author":"Brouwer","year":"2021","journal-title":"Ann Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib10","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.suronc.2018.02.007","article-title":"Beyond T, N and M: the impact of tumor deposits on the staging and treatment of colorectal and gastric carcinoma","volume":"27","author":"Peparini","year":"2018","journal-title":"Surg Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib11","doi-asserted-by":"crossref","DOI":"10.1200\/JCO.2016.68.9091","article-title":"Tumor deposits in colorectal cancer: improving the value of modern Staging-A systematic review and meta-analysis","volume":"35","author":"Nagtegaal","year":"2017","journal-title":"J Clin Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib12","doi-asserted-by":"crossref","DOI":"10.1016\/j.ctrv.2021.102325","article-title":"A comprehensive overview of tumour deposits in colorectal cancer: towards a next TNM classification","volume":"103","author":"Delattre","year":"2022","journal-title":"Cancer Treat Rev"},{"key":"10.1016\/j.ejso.2025.110420_bib13","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ejca.2017.05.027","article-title":"Significance of extranodal tumour deposits in colorectal cancer: a systematic review and meta-analysis","volume":"82","author":"Lord","year":"2017","journal-title":"Eur J Cancer"},{"key":"10.1016\/j.ejso.2025.110420_bib14","doi-asserted-by":"crossref","DOI":"10.1002\/ags3.12652","article-title":"Tumor deposits in colorectal cancer: refining their definition in the TNM system","volume":"7","author":"Ueno","year":"2023","journal-title":"Ann Gastroenterol Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib15","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1080\/0284186X.2018.1529425","article-title":"Evaluation of the Swedish colorectal cancer registry: an overview of completeness, timeliness, comparability and validity","volume":"57","author":"Moberger","year":"2018","journal-title":"Acta Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib16","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1080\/0284186X.2021.1896033","article-title":"Completeness and accuracy of the registration of recurrences in the Swedish colorectal cancer registry (SCRCR) and an update of recurrence risk in colon cancer","volume":"60","author":"Osterman","year":"2021","journal-title":"Acta Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib18","doi-asserted-by":"crossref","DOI":"10.1016\/j.pathol.2022.07.014","article-title":"What are the problems with the current staging of discontinuous tumour nodules (DTNs) in colorectal carcinoma? Is there a better way?","volume":"54","author":"Karbanowicz","year":"2022","journal-title":"Pathology"},{"key":"10.1016\/j.ejso.2025.110420_bib19","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/SLA.0b013e31821ad8a2","article-title":"Is the seventh edition of the UICC\/AJCC TNM staging system reasonable for patients with tumor deposits in colorectal cancer?","volume":"255","author":"Tong","year":"2012","journal-title":"Ann Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib20","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.gassur.2023.11.003","article-title":"Presence of tumor deposits is a strong indicator of poor outcome in patients with stage III colorectal cancers undergoing radical surgery","volume":"28","author":"Lieto","year":"2024","journal-title":"J Gastrointest Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib21","doi-asserted-by":"crossref","DOI":"10.1186\/s12957-023-03299-w","article-title":"Combining pathological risk factors and T, N staging to optimize the assessment for risk stratification and prognostication in low-risk stage III colon cancer","volume":"22","author":"Xian","year":"2024","journal-title":"World J Surg Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib22","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.sopen.2025.02.004","article-title":"Prognostic significance of tumor deposit counts in stage III colorectal cancer based on T\/N staging and chemotherapy status: a retrospective cohort study","volume":"24","author":"Zheng","year":"2025","journal-title":"Surgery Open Science"},{"key":"10.1016\/j.ejso.2025.110420_bib23","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/COC.0000000000000645","article-title":"Tumor deposits in stage III Colon cancer: correlation with other histopathologic variables, prognostic value, and risk stratification-time to consider \"N2c\"","volume":"43","author":"Pricolo","year":"2020","journal-title":"Am J Clin Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib24","article-title":"How best to play the role of tumor deposits in stage III Colon cancer?","volume":"12","author":"Liu","year":"2022","journal-title":"Front Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib25","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2020.571154","article-title":"A modified tumor-node-metastasis classification for stage III colorectal cancers based on treating tumor deposits as positive lymph nodes","volume":"7","author":"Pei","year":"2020","journal-title":"Front Med"},{"key":"10.1016\/j.ejso.2025.110420_bib26","article-title":"The new 'coN' staging system combining lymph node metastasis and tumour deposit provides a more accurate prognosis for TNM stage III colon cancer","volume":"12","author":"Wang","year":"2023","journal-title":"Cancer Med"},{"key":"10.1016\/j.ejso.2025.110420_bib27","article-title":"Readjustment of nodal staging by integrating tumor deposits and positive lymph nodes in patients with stage III colon cancer: a population-based analysis","volume":"13","author":"Lin","year":"2023","journal-title":"Am J Cancer Res"},{"key":"10.1016\/j.ejso.2025.110420_bib28","doi-asserted-by":"crossref","DOI":"10.1097\/SLA.0000000000005355","article-title":"Revised nodal staging integrating tumor deposit counts with positive lymph nodes in patients with stage III Colon cancer","volume":"277","author":"Pyo","year":"2023","journal-title":"Ann Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib29","article-title":"Can the tumor deposits be counted as metastatic lymph nodes in the UICC TNM staging system for colorectal cancer?","volume":"7","author":"Song","year":"2012","journal-title":"PLoS One"},{"key":"10.1016\/j.ejso.2025.110420_bib30","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1002\/cam4.2034","article-title":"Poor prognostic and staging value of tumor deposit in locally advanced rectal cancer with neoadjuvant chemoradiotherapy","volume":"8","author":"Wang","year":"2019","journal-title":"Cancer Med"},{"key":"10.1016\/j.ejso.2025.110420_bib31","doi-asserted-by":"crossref","first-page":"18269","DOI":"10.18632\/oncotarget.7756","article-title":"Tumor deposits counted as positive lymph nodes in TNM staging for advanced colorectal cancer: a retrospective multicenter study","volume":"7","author":"Li","year":"2016","journal-title":"Oncotarget"},{"key":"10.1016\/j.ejso.2025.110420_bib32","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2020.548692","article-title":"A modified pathological N stage including status of tumor deposits in colorectal cancer with nodal metastasis","volume":"10","author":"Pei","year":"2020","journal-title":"Front Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib33","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s00384-022-04149-z","article-title":"Significance of tumor deposits combined with lymph node metastasis in stage III colorectal cancer patients: a retrospective multi-center cohort study from China","volume":"37","author":"Pu","year":"2022","journal-title":"Int J Colorectal Dis"},{"key":"10.1016\/j.ejso.2025.110420_bib34","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.4251\/wjgo.v14.i9.1699","article-title":"Prognostic impact of tumor deposits on overall survival in colorectal cancer: based on surveillance, epidemiology, and end results database","volume":"14","author":"Wu","year":"2022","journal-title":"World J Gastrointest Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib35","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/j.annonc.2021.07.009","article-title":"Combining tumor deposits with the number of lymph node metastases to improve the prognostic accuracy in stage III colon cancer: a post hoc analysis of the CALGB\/SWOG 80702 phase III study (Alliance)(\u2606)","volume":"32","author":"Cohen","year":"2021","journal-title":"Ann Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib36","doi-asserted-by":"crossref","DOI":"10.1200\/JCO.2019.37.15_suppl.3519","article-title":"Prognostic value of tumor deposits for disease free survival in patients with stage III colon cancer: a post hoc analysis of IDEA France phase III trial (PRODIGE-GERCOR)","volume":"37","author":"Delattre","year":"2019","journal-title":"J Clin Oncol"},{"key":"10.1016\/j.ejso.2025.110420_bib37","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1038\/s41598-019-57041-2","article-title":"Reconsidering the prognostic significance of tumour deposit count in the TNM staging system for colorectal cancer","volume":"10","author":"Wang","year":"2020","journal-title":"Sci Rep"},{"key":"10.1016\/j.ejso.2025.110420_bib38","doi-asserted-by":"crossref","first-page":"73865","DOI":"10.18632\/oncotarget.12076","article-title":"Novel lymph node ratio predicts prognosis of colorectal cancer patients after radical surgery when tumor deposits are counted as positive lymph nodes: a retrospective multicenter study","volume":"7","author":"Yang","year":"2016","journal-title":"Oncotarget"},{"key":"10.1016\/j.ejso.2025.110420_bib39","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2024.6729","article-title":"Validated integration of tumor deposits in N staging for prognostication in Colon cancer","author":"Sassun","year":"2025","journal-title":"JAMA Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib40","doi-asserted-by":"crossref","first-page":"e346","DOI":"10.1097\/SLA.0000000000005302","article-title":"Circumferential resection Margin is associated with distant metastasis after rectal cancer surgery: a nation-wide population-based study cohort","volume":"277","author":"Agger","year":"2023","journal-title":"Ann Surg"},{"key":"10.1016\/j.ejso.2025.110420_bib41","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.ejca.2022.07.020","article-title":"Deficient mismatch repair\/microsatellite unstable colorectal cancer: diagnosis, prognosis and treatment","volume":"175","author":"Taieb","year":"2022","journal-title":"Eur J Cancer"},{"key":"10.1016\/j.ejso.2025.110420_bib42","doi-asserted-by":"crossref","DOI":"10.2147\/CLEP.S466029","article-title":"A validation of the Swedish colorectal cancer register - with focus on histopathology, complications and recurrences","volume":"16","author":"Arnarson","year":"2024","journal-title":"Clin Epidemiol"},{"key":"10.1016\/j.ejso.2025.110420_bib43","article-title":"Adjuvant chemotherapy duration and disease-free survival in low-risk stage III Colon cancer with N1a-b and N1c disease: insights from a single-center retrospective analysis","author":"Karao\u011flan","year":"2024","journal-title":"J Gastrointest Cancer"},{"key":"10.1016\/j.ejso.2025.110420_bib44","doi-asserted-by":"crossref","DOI":"10.1111\/codi.15406","article-title":"N1c Colon cancer and the use of adjuvant chemotherapy: a current audit of the national cancer database","volume":"23","author":"Simon","year":"2021","journal-title":"Colorectal Dis"},{"key":"10.1016\/j.ejso.2025.110420_bib45","article-title":"The prognostic value of adjuvant chemotherapy in Colon cancer with Solitary tumor deposit","volume":"12","author":"Lin","year":"2022","journal-title":"Front Oncol"}],"container-title":["European Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0748798325008480?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0748798325008480?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:24:51Z","timestamp":1772825091000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0748798325008480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":44,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["S0748798325008480"],"URL":"https:\/\/doi.org\/10.1016\/j.ejso.2025.110420","relation":{},"ISSN":["0748-7983"],"issn-type":[{"value":"0748-7983","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Rethinking TNM: Tumor deposit-based prognostic models may improve N-staging in colorectal cancer","name":"articletitle","label":"Article Title"},{"value":"European Journal of Surgical Oncology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ejso.2025.110420","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Author(s). Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"110420"}}