{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:13:39Z","timestamp":1788416019154,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tumour deposits (TDs) without metastatic lymph nodes are classified as N1c in the 8th edition of the AJCC staging manual. However, the prognostic value of TDs and lymph node ratio (LNR) in stage III colorectal cancer (CRC) remains unclear. This study aimed to compare the prognostic significance of TD count and LNR with the newly developed modified lymph node ratio (mLNR), and to create a prognostic nomogram integrating mLNR for stage III CRC patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the SEER database, a training cohort of 25,689 stage III CRC patients was identified, alongside an external validation cohort of 563 patients from a hospital in China. Modified lymph node ratio (mLNR) was defined by combining TD count and LNR. The effects of TDs, LNR, and mLNR on cancer-specific survival (CSS) and overall survival (OS) were evaluated using Kaplan-Meier curves and Cox regression models. A nomogram incorporating mLNR was developed for prognosis prediction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In both cohorts, TDs positivity was associated with poorer CSS (all P &amp;lt; 0.001). Multiple TDs correlated with worse CSS than a single TD (training: HR, 1.978; validation: HR, 1.805). High mLNR indicated a significantly higher risk of CRC-specific death (training: HR, 2.421; validation: HR, 4.60). The nomogram incorporating mLNR demonstrated good discrimination and calibration in both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>mLNR is an independent prognostic factor for stage III CRC. The nomogram combining mLNR can effectively identify high-risk patients, aiding treatment decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1910628","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:23:14Z","timestamp":1788412994000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of a modified lymph node ratio for combined colorectal cancer tumour deposits: a population-based study"],"prefix":"10.3389","volume":"16","author":[{"given":"Mingming","family":"Song","sequence":"first","affiliation":[{"name":"Department of General Surgery, The Second People\u2019s Hospital of Hefei Affiliated to Bengbu Medical University","place":["Hefei, China"]},{"name":"Department of General Surgery, The Second People\u2019s Hospital of Hefei","place":["Hefei, China"]},{"name":"Department of Urology, Harbin Medical University Cancer Hospital","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feihong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Heng","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Shihezi University","place":["Shihezi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Liu","sequence":"additional","affiliation":[{"name":"China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Shihezi University","place":["Shihezi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Shihezi University","place":["Shihezi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoling","family":"Zhi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine","place":["Wuhan, China"]},{"name":"Hubei Province Key Laboratory of Molecular Imaging","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanrui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Shihezi University","place":["Shihezi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhixiang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menghui","family":"Dai","sequence":"additional","affiliation":[{"name":"Cancer center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Urology, Harbin Medical University Cancer Hospital","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Second People\u2019s Hospital of Hefei Affiliated to Bengbu Medical University","place":["Hefei, China"]},{"name":"Department of General Surgery, The Second People\u2019s Hospital of Hefei","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.385","article-title":"Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial","volume":"307","author":"Alberts","year":"2012","journal-title":"JAMA"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-018-0264-x","article-title":"The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention","volume":"119","author":"Brenner","year":"2018","journal-title":"Br J Cancer"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000001295","article-title":"Prognostic value of tumor deposits and positive lymph node ratio in stage III colorectal cancer: a retrospective cohort study","volume":"110","author":"Liu","year":"2024","journal-title":"Int J Surg"},{"key":"B5","doi-asserted-by":"publisher","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":"B6","volume-title":"Digestive Tumours","year":"2026"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.34.6429","article-title":"Lymph nodes, tumor deposits, and TNM: are we getting better","volume":"29","author":"Nagtegaal","year":"2011","journal-title":"J Clin Oncol"},{"key":"B8","doi-asserted-by":"publisher","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)","volume":"32","author":"Cohen","year":"2021","journal-title":"Ann Oncol"},{"key":"B9","doi-asserted-by":"publisher","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":"B10","doi-asserted-by":"publisher","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":"B11","doi-asserted-by":"publisher","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":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/codi.14289","article-title":"Prognostic value and characteristics of N1c colorectal cancer","volume":"20","author":"Bouquot","year":"2018","journal-title":"Colorectal Dis"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181ffa780","article-title":"Lymph node ratio as a quality and prognostic indicator in stage III colon cancer","volume":"253","author":"Chen","year":"2011","journal-title":"Ann Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318197f2c8","article-title":"Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer","volume":"249","author":"Wang","year":"2009","journal-title":"Ann Surg"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21830","article-title":"Lymph node ratio as determined by the 7th edition of the American Joint Committee on Cancer staging system predicts survival in stage III colon cancer","volume":"103","author":"Hong","year":"2011","journal-title":"J Surg Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-017-3382-5","article-title":"Lymph node ratio as a risk factor for recurrence after adjuvant chemotherapy in stage III colorectal cancer","volume":"21","author":"Ooki","year":"2017","journal-title":"J Gastrointest Surg"},{"key":"B17","article-title":"Lymph node ratio may predict relapse free survival and overall survival in patients with stage II & III colorectal carcinoma","volume":"62","author":"Zekri","year":"2015","journal-title":"Hepatogastroenterology"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2051-4","article-title":"The impact of the lymph node ratio is greater than traditional lymph node status in stage III colorectal cancer patients","volume":"37","author":"Lu","year":"2013","journal-title":"World J Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.4420","article-title":"Association of preoperative and postoperative serum carcinoembryonic antigen and colon cancer outcome","volume":"4","author":"Konishi","year":"2018","journal-title":"JAMA Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.14740\/gr1062w","article-title":"Difference between left-sided and right-sided colorectal cancer: a focused review of literature","volume":"11","author":"Baran","year":"2018","journal-title":"Gastroenterol Res"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27968","article-title":"Assessing the utility of cancer-registry-processed cause of death in calculating cancer-specific survival","volume":"119","author":"Hu","year":"2013","journal-title":"Cancer"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.soc.2017.11.011","article-title":"Lymph node metastasis in colorectal cancer","volume":"27","author":"Jin","year":"2018","journal-title":"Surg Oncol Clin N Am"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(20000515)88:10<2228::AID-CNCR5>3.0.CO;2-1","article-title":"Pericolonic tumor deposits in patients with T3N+MO colon adenocarcinomas: markers of reduced disease free survival and intra-abdominal metastases and their implications for TNM classification","volume":"88","author":"Goldstein","year":"2000","journal-title":"Cancer"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19880601)61:11<2310::aid-cncr2820611127>3.0.co;2-x","article-title":"TNM classification of Malignant tumors. A comparison between the new (1987) and the old editions","volume":"61","author":"Sobin","year":"1988","journal-title":"Cancer"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-0985-4","article-title":"The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM","volume":"17","author":"Edge","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21388","article-title":"The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"B27","doi-asserted-by":"publisher","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":"B28","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6661-9","article-title":"Prognostic significance of tumor deposits in stage III colon cancer","volume":"25","author":"Mirkin","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0310327","article-title":"Negative prognostic impact of tumor deposits in stage III colorectal cancer patients","volume":"19","author":"Ma","year":"2024","journal-title":"PloS One"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1177\/000313482008600238","article-title":"Prognostic significance of tumor deposits in combination with lymph node metastasis in stage III colon cancer: a propensity score matching study","volume":"86","author":"Zheng","year":"2020","journal-title":"Am Surg"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/his.12936","article-title":"Prognostic value of tumour deposit and perineural invasion status in colorectal cancer patients: a SEER-based population study","volume":"69","author":"Mayo","year":"2016","journal-title":"Histopathology"},{"key":"B32","doi-asserted-by":"publisher","first-page":"769","DOI":"10.21037\/atm.2019.11.69","article-title":"The unique prognostic characteristics of tumor deposits in colorectal cancer patients","volume":"7","author":"Liu","year":"2019","journal-title":"Ann Transl Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.07.099","article-title":"Prognostic significance of tumor deposits in patients with stage III colon cancer: a nomogram study","volume":"245","author":"Zheng","year":"2020","journal-title":"J Surg Res"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01960","article-title":"Prognostic value of tumor deposits for disease-free survival in patients with stage III colon cancer: a post hoc analysis of the IDEA France phase III trial (PRODIGE-GERCOR)","volume":"38","author":"Delattre","year":"2020","journal-title":"J Clin Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1910628\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:23:15Z","timestamp":1788412995000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1910628\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":34,"alternative-id":["10.3389\/fonc.2026.1910628"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1910628","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1910628"}}