O Abdel-Rahman1. 1. Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lotfy Elsayed Street, Cairo, 11566, Egypt. omar.abdelrhman@med.asu.edu.eg.
Abstract
BACKGROUND: The current study tried to evaluate the prognostic value of a modified staging system compared to the American Joint Committee on Cancer (AJCC) staging system for patients with colon cancer. PATIENTS AND METHODS: Surveillance, epidemiology and end results (SEER) database (2004-2014) was queried through SEER*Stat program and AJCC 7th stages were constructed. Through recursive partitioning analysis and subsequent decision tree formation, suggested new stages were formulated based on T and N descriptors. Overall survival analyses were performed through Kaplan-Meier analysis. The cancer-specific Cox regression hazard (adjusted for age, gender, sub-site, grade, race and surgery) was calculated and pair wise comparisons of hazard ratios were conducted. RESULTS: A total of 159,683 non-metastatic patients with colon cancer were recruited in the analysis. Pair wise hazard ratio comparisons among different AJCC 7th stages were conducted and all comparisons were significant (P < 0.0001). However, it should be noted that the adjusted risk of death among stage IIC patients was higher than stage IIIA and IIIB. Pair wise hazard ratio comparisons among different modified system stages were also conducted and all comparisons were significant (P < 0.0001). The outcomes of survival analysis were the same regardless of the number of examined lymph nodes (< 12 vs. ≥ 12). Concordance index (using death from colon cancer as the dependent variable) for AJCC 6th staging system was 0.704 (SE 0.002; 95% CI 0.701-0.708); for AJCC 7th staging system was 0.708 (SE 0.002; 95% CI 0.704-0.711); for Dukes staging system was 0.670 (SE 0.002; 95% CI 0.666-0.674); and for modified staging system was 0.712 (SE 0.002; 95% CI 0.709-0.716). CONCLUSION: The proposed modified staging system provided an improved prognostication for colon cancer patients (particularly for stage II/III disease) compared to AJCC staging system. Further external validation of the proposed staging system is needed before adoption into routine practice.
BACKGROUND: The current study tried to evaluate the prognostic value of a modified staging system compared to the American Joint Committee on Cancer (AJCC) staging system for patients with colon cancer. PATIENTS AND METHODS: Surveillance, epidemiology and end results (SEER) database (2004-2014) was queried through SEER*Stat program and AJCC 7th stages were constructed. Through recursive partitioning analysis and subsequent decision tree formation, suggested new stages were formulated based on T and N descriptors. Overall survival analyses were performed through Kaplan-Meier analysis. The cancer-specific Cox regression hazard (adjusted for age, gender, sub-site, grade, race and surgery) was calculated and pair wise comparisons of hazard ratios were conducted. RESULTS: A total of 159,683 non-metastatic patients with colon cancer were recruited in the analysis. Pair wise hazard ratio comparisons among different AJCC 7th stages were conducted and all comparisons were significant (P < 0.0001). However, it should be noted that the adjusted risk of death among stage IIC patients was higher than stage IIIA and IIIB. Pair wise hazard ratio comparisons among different modified system stages were also conducted and all comparisons were significant (P < 0.0001). The outcomes of survival analysis were the same regardless of the number of examined lymph nodes (< 12 vs. ≥ 12). Concordance index (using death from colon cancer as the dependent variable) for AJCC 6th staging system was 0.704 (SE 0.002; 95% CI 0.701-0.708); for AJCC 7th staging system was 0.708 (SE 0.002; 95% CI 0.704-0.711); for Dukes staging system was 0.670 (SE 0.002; 95% CI 0.666-0.674); and for modified staging system was 0.712 (SE 0.002; 95% CI 0.709-0.716). CONCLUSION: The proposed modified staging system provided an improved prognostication for colon cancerpatients (particularly for stage II/III disease) compared to AJCC staging system. Further external validation of the proposed staging system is needed before adoption into routine practice.
Authors: H J Schmoll; E Van Cutsem; A Stein; V Valentini; B Glimelius; K Haustermans; B Nordlinger; C J van de Velde; J Balmana; J Regula; I D Nagtegaal; R G Beets-Tan; D Arnold; F Ciardiello; P Hoff; D Kerr; C H Köhne; R Labianca; T Price; W Scheithauer; A Sobrero; J Tabernero; D Aderka; S Barroso; G Bodoky; J Y Douillard; H El Ghazaly; J Gallardo; A Garin; R Glynne-Jones; K Jordan; A Meshcheryakov; D Papamichail; P Pfeiffer; I Souglakos; S Turhal; A Cervantes Journal: Ann Oncol Date: 2012-10 Impact factor: 32.976
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Authors: Cornelis J H van de Velde; Petra G Boelens; Josep M Borras; Jan-Willem Coebergh; Andres Cervantes; Lennart Blomqvist; Regina G H Beets-Tan; Colette B M van den Broek; Gina Brown; Eric Van Cutsem; Eloy Espin; Karin Haustermans; Bengt Glimelius; Lene H Iversen; J Han van Krieken; Corrie A M Marijnen; Geoffrey Henning; Jola Gore-Booth; Elisa Meldolesi; Pawel Mroczkowski; Iris Nagtegaal; Peter Naredi; Hector Ortiz; Lars Påhlman; Philip Quirke; Claus Rödel; Arnaud Roth; Harm Rutten; Hans J Schmoll; Jason J Smith; Pieter J Tanis; Claire Taylor; Arne Wibe; Theo Wiggers; Maria A Gambacorta; Cynthia Aristei; Vincenzo Valentini Journal: Eur J Cancer Date: 2013-10-31 Impact factor: 9.162