淋巴结转移 (LNM) 在结直肠癌 (CRC) 的肿瘤-淋巴结-转移 (TNM) 分类中发挥着核心作用，结外扩散 (ENE) 是一个不利特征。 ENE 从未与肿瘤沉积物 (TD) 进行直接比较。本研究的目的是进行最新的系统评价，包括网络荟萃分析以比较其预后价值。对 PubMed、Embase、Web of Science 和 Cochrane 数据库进行了全面检索，以确定所有关于 ENE 和 TD 的预后研究。共纳入20项研究，7719例。主要结局是 5 年无病生存率 (DFS)；次要结局是总生存期（OS）和疾病特异性生存期（DSS）。使用 R 中的 netmeta 包进行频率配对和网络荟萃分析。对于单变量 DFS 分析，与 LNM   ENE 病例相比，LNM  TD 病例的结果明显更差[风险比 (HR) = 1.27，95% 置信区间 (CI) = 1.06-1.53​​]，这对于多变量 DFS 分析不再显着（HR = 1.13，95% CI = 0.87-1.46）。所有 OS 和多变量 DSS 分析均显示，与 LNM   ENE 病例相比，LNM   TD 病例的结果明显较差。对于所有结果，与 LNM 病例相比，LNM  TD 和 LNM  ENE 的风险显着增加。这项研究表明，LNM  TD 的结果有比 LNM  ENE 更差的趋势，在多变量 DFS 分析中不具有统计显着性。两组的表现均明显差于仅采用 LNM 的病例。为了提高 CRC 分期的准确性，我们建议在 TNM 分类中更加重视 ENE 和 TD，其中 TD 的作用最为突出。© 2024 作者。组织病理学由约翰·威利出版

Lymph node metastases (LNM) play a central role in the tumour-node-metastasis (TNM) classification for colorectal cancer (CRC), with extranodal extension (ENE) as an adverse feature. ENE has never been directly compared to tumour deposits (TD). The aim of this study was to perform an up-to-date systematic review, including a network meta-analysis to compare their prognostic value. A comprehensive search was conducted on PubMed, Embase, Web of Science and Cochrane databases to identify all prognostic studies on ENE and TD. A total of 20 studies were included, with 7719 cases. The primary outcome was 5-year disease-free survival (DFS); secondary outcomes were overall survival (OS) and disease-specific survival (DSS). Frequentist paired and network meta-analyses were performed using the netmeta package in R. For univariable DFS analysis, LNM + TD+ cases had a significantly worse outcome compared with LNM + ENE+ cases [hazard ratio (HR) = 1.27, 95% confidence interval (CI) = 1.06-1.53], which was no longer significant for multivariable DFS analysis (HR = 1.13, 95% CI = 0.87-1.46). All OS and multivariable DSS analyses showed a significantly worse outcome for LNM + TD+ cases compared with LNM + ENE cases. For all outcomes, both LNM + TD+ and LNM + ENE+ had a significantly increased hazard compared with LNM+ cases. This study shows that there is a trend towards worse outcome for LNM + TD+ than LNM + ENE+, not statistically significant in multivariable DFS analysis. Both groups perform significantly worse than cases with LNM only. To improve the accuracy of CRC staging, we recommend to put more emphasis on both ENE and TD in the TNM classification, with the most prominent role for TD.© 2024 The Author(s). Histopathology published by John Wiley & Sons Ltd.