{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:55:19Z","timestamp":1790765719810,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["202308510063"],"award-info":[{"award-number":["202308510063"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Lymph node metastases (LNM) are traditionally regarded as the principal gateway for distant metastases in colorectal cancer (CRC), forming the foundation of TNM staging. Tumour deposits (TD) have emerged as a strong prognostic factor and potential alternative gateway for CRC spread. This study aimed to assess whether TD were associated with the risk of distant metastases and to characterize metastatic patterns and burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      A retrospective, population\u2010based study included 3505 CRC patients without distant metastases at diagnosis, using data from the Netherlands Cancer Registry for the first half of 2015. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for metastatic risk. Metastatic patterns were summarized descriptively using pattern\u2010to\u2010patient ratios. Metastatic burden was categorized by the number of involved sites (1, 2, 3 or\u00a0\u22654) and evaluated using the linear\u2010by\u2010linear association test. Of the 3505 patients, 2268 were N0, 934 were LNM+ and 303 were LNM\u2009+\u2009TD+. TD were independently associated with an increased risk of distant metastases (HR\u2009=\u20091.34, 95% CI: 1.03\u20131.74). Among patients who developed distant metastases, pattern\u2010to\u2010patient ratios were 0.30, 0.34 and 0.39 in the N0, LNM+ and LNM\u2009+\u2009TD+ groups, respectively, but were not formally compared because of their dependence on sample size. The distribution of metastatic burden differed across the three groups (\n                      <jats:italic>P<\/jats:italic>\n                      for trend\u2009=\u20090.017). The proportion with \u22654 involved sites was descriptively highest in the LNM\u2009+\u2009TD+ group (18.0% vs. 11.0% in LNM+ and 9.2% in N0).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TD are independently associated with an increased risk of distant metastases in CRC. This finding supports\u00a0consideration of TD in future risk stratification strategies and warrant further investigation into whether TD mark a distinct metastatic phenotype rather than merely reflecting locoregional disease progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.70297","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:57:23Z","timestamp":1790762243000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tumour deposits are associated with increased metastatic risk in colorectal cancer: a population\u2010based analysis of metastatic patterns and burden"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4725-8109","authenticated-orcid":false,"given":"Yao","family":"Shu","sequence":"first","affiliation":[{"name":"Department of Pathology Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2268-9668","authenticated-orcid":false,"given":"Nelleke P M","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Pathology Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3986-4776","authenticated-orcid":false,"given":"Marloes A G","family":"Elferink","sequence":"additional","affiliation":[{"name":"Department of Research and Development Netherlands Comprehensive Cancer Organization  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6773-9668","authenticated-orcid":false,"given":"Johannes H W","family":"de Wilt","sequence":"additional","affiliation":[{"name":"Department of Surgery Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3020-1896","authenticated-orcid":false,"given":"Femke","family":"Simmer","sequence":"additional","affiliation":[{"name":"Department of Pathology Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0887-4127","authenticated-orcid":false,"given":"Iris D","family":"Nagtegaal","sequence":"additional","affiliation":[{"name":"Department of Pathology Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1002\/ijc.31785","article-title":"An overview of 25\u2009years of incidence, treatment and outcome of colorectal cancer patients","volume":"143","author":"Brouwer NPM","year":"2018","journal-title":"Int. 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