BACKGROUND: The 7th edition of the AJCC Cancer Staging Manual (AJCC-7) includes substantial changes for colon cancer (CC), which are particularly complex in patients with stage II and III disease. We used a national cancer database to determine if these changes improved prediction of survival. STUDY DESIGN: The database of the Surveillance, Epidemiology and End Results Program was queried to identify patients with pathologically confirmed stage I to III CC diagnosed between 1988 and 2008. Colon cancer was staged by the 6(th) edition of the AJCC Cancer Staging Manual (AJCC-6) and then restaged by AJCC-7. Five-year disease-specific survival and overall survival were compared. RESULTS: After all exclusion criteria were applied, AJCC-6 and AJCC-7 staging was possible in 157,588 patients (68.9%). Bowker's test of symmetry showed that the number of patients per substage was different for AJCC-6 and AJCC-7 (p < 0.001). The Akaike information criteria comparison showed superior fit with the AJCC-7 model (p < 0.001). However, although AJCC-7 staging yielded a progressive decrease in disease-specific survival and overall survival of patients with stage IIA (86.3% and 72.4%, respectively), IIB (79.4% and 63.2%, respectively), and IIC (64.9% and 54.6%, respectively) CC, disease-specific survival and overall survival of patients with stage IIIA disease increased (89% and 79%, respectively). Subset analysis of patients with >12 lymph nodes examined did not affect this observation. CONCLUSIONS: The AJCC-7 staging of CC does not address all survival discrepancies, regardless of the number of lymph nodes examined. Consideration of other prognostic factors is critical for decisions about therapy, particularly for patients with stage II CC.
BACKGROUND: The 7th edition of the AJCC Cancer Staging Manual (AJCC-7) includes substantial changes for colon cancer (CC), which are particularly complex in patients with stage II and III disease. We used a national cancer database to determine if these changes improved prediction of survival. STUDY DESIGN: The database of the Surveillance, Epidemiology and End Results Program was queried to identify patients with pathologically confirmed stage I to III CC diagnosed between 1988 and 2008. Colon cancer was staged by the 6(th) edition of the AJCC Cancer Staging Manual (AJCC-6) and then restaged by AJCC-7. Five-year disease-specific survival and overall survival were compared. RESULTS: After all exclusion criteria were applied, AJCC-6 and AJCC-7 staging was possible in 157,588 patients (68.9%). Bowker's test of symmetry showed that the number of patients per substage was different for AJCC-6 and AJCC-7 (p < 0.001). The Akaike information criteria comparison showed superior fit with the AJCC-7 model (p < 0.001). However, although AJCC-7 staging yielded a progressive decrease in disease-specific survival and overall survival of patients with stage IIA (86.3% and 72.4%, respectively), IIB (79.4% and 63.2%, respectively), and IIC (64.9% and 54.6%, respectively) CC, disease-specific survival and overall survival of patients with stage IIIA disease increased (89% and 79%, respectively). Subset analysis of patients with >12 lymph nodes examined did not affect this observation. CONCLUSIONS: The AJCC-7 staging of CC does not address all survival discrepancies, regardless of the number of lymph nodes examined. Consideration of other prognostic factors is critical for decisions about therapy, particularly for patients with stage II CC.
Authors: C C Compton; L P Fielding; L J Burgart; B Conley; H S Cooper; S R Hamilton; M E Hammond; D E Henson; R V Hutter; R B Nagle; M L Nielsen; D J Sargent; C R Taylor; M Welton; C Willett Journal: Arch Pathol Lab Med Date: 2000-07 Impact factor: 5.534
Authors: Arnaud D Roth; Mauro Delorenzi; Sabine Tejpar; Pu Yan; Dirk Klingbiel; Roberto Fiocca; Giovanni d'Ario; Laura Cisar; Roberto Labianca; David Cunningham; Bernard Nordlinger; Fred Bosman; Eric Van Cutsem Journal: J Natl Cancer Inst Date: 2012-10-25 Impact factor: 13.506
Authors: Alexander Stojadinovic; Aviram Nissan; Mladjan Protic; Carol F Adair; Diana Prus; Slavica Usaj; Robin S Howard; Dragan Radovanovic; Milan Breberina; Craig D Shriver; Ronit Grinbaum; Jeffery M Nelson; Tommy A Brown; Herbert R Freund; John F Potter; Tamar Peretz; George E Peoples Journal: Ann Surg Date: 2007-06 Impact factor: 12.969
Authors: Noemi Eiro; Juan Francisco Carrión; Sandra Cid; Alejandro Andicoechea; José Luis García-Muñiz; Luis O González; Francisco J Vizoso Journal: Pathol Oncol Res Date: 2019-02-01 Impact factor: 3.201