The prognostic impact of imaging detected tumor deposits in rectal cancer: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Sekhon, Harpreet
Lord, Amy
Pawa, Nikhil
Brown, Gina
Type
Journal Article
Abstract
Background
Tumor deposits (TDs) identified at pathology post rectal cancer resection are increasingly recognized as an adverse prognostic factor. Advances in magnetic resonance imaging (MRI) allow for the preoperative detection of TDs (mrTDs), raising the possibility that patients with mrTDs may benefit from neoadjuvant treatment strategies or enhanced surveillance.
Objective
This meta-analysis primarily aims to evaluate the prognostic significance of mrTDs in rectal cancer patients. We also evaluate the impact of other prognostic features.
Methods
A comprehensive search was conducted in MEDLINE, Embase, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Prognostic endpoints included disease-free survival (DFS) and overall survival (OS). Pooled hazard ratios (HR) were calculated using R software.
Results
Overall, 5813 and 5630 patients were included in the systematic review (13 studies) and meta-analysis (11 studies), respectively. The pooled HR for OS and DFS for mrTDs was 2.1 (95% confidence interval [CI] 1.63–2.70; p < 0.0001) and 2.13 (95% CI 1.68–2.71; p < 0.0001), respectively. The pooled HR for OS and DFS for extramural venous invasion (mrEMVI) and circumferential resection margin (mrCRM) involvement was also significantly increased (p < 0.01). The pooled HR for MRI-predicted nodal disease (mrLNMs) and T stage (mrT) for OS and DFS was insignificant (p > 0.05).
Conclusion
This meta-analysis confirms the prognostic significance of mrTDs on OS and DFS in rectal cancer. This was also observed for mrEMVI and mrCRM, but not for mrLNMs or mrT. Current staging using TNM has poor prognostic power. A novel evidence-based staging system is needed to identify high risk patients and guide preoperative treatment strategies.
Trial registration The protocol for this study was registered in the PROSPERO database (CRD420251011285)
Tumor deposits (TDs) identified at pathology post rectal cancer resection are increasingly recognized as an adverse prognostic factor. Advances in magnetic resonance imaging (MRI) allow for the preoperative detection of TDs (mrTDs), raising the possibility that patients with mrTDs may benefit from neoadjuvant treatment strategies or enhanced surveillance.
Objective
This meta-analysis primarily aims to evaluate the prognostic significance of mrTDs in rectal cancer patients. We also evaluate the impact of other prognostic features.
Methods
A comprehensive search was conducted in MEDLINE, Embase, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Prognostic endpoints included disease-free survival (DFS) and overall survival (OS). Pooled hazard ratios (HR) were calculated using R software.
Results
Overall, 5813 and 5630 patients were included in the systematic review (13 studies) and meta-analysis (11 studies), respectively. The pooled HR for OS and DFS for mrTDs was 2.1 (95% confidence interval [CI] 1.63–2.70; p < 0.0001) and 2.13 (95% CI 1.68–2.71; p < 0.0001), respectively. The pooled HR for OS and DFS for extramural venous invasion (mrEMVI) and circumferential resection margin (mrCRM) involvement was also significantly increased (p < 0.01). The pooled HR for MRI-predicted nodal disease (mrLNMs) and T stage (mrT) for OS and DFS was insignificant (p > 0.05).
Conclusion
This meta-analysis confirms the prognostic significance of mrTDs on OS and DFS in rectal cancer. This was also observed for mrEMVI and mrCRM, but not for mrLNMs or mrT. Current staging using TNM has poor prognostic power. A novel evidence-based staging system is needed to identify high risk patients and guide preoperative treatment strategies.
Trial registration The protocol for this study was registered in the PROSPERO database (CRD420251011285)
Date Issued
2026-01-01
Date Acceptance
2025-08-31
Citation
Annals of Surgical Oncology, 2026, 33 (1), pp.199-209
ISSN
1068-9265
Publisher
Springer
Start Page
199
End Page
209
Journal / Book Title
Annals of Surgical Oncology
Volume
33
Issue
1
Copyright Statement
© The Author(s) 2025 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Publication Status
Published
Date Publish Online
2025-09-30