AJCC Cancer Staging Manual 7^th Edition Criteria for Colon Cancer: Do the Complex Modifications Improve Prognostic Assessment?

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• 作者：Danielle M. Hari ; Anna M. Leung ; Ji-Hey Lee ; Myung-Shin Sim ; Brooke Vuong ; Connie G. Chiu ; Anton J. Bilchik
• 关键词：AIC ; Akaike information criterion ; AJCC ; American Joint Committee on Cancer ; AJCC-6 ; AJCC Cancer Staging Manual ; 6th edition ; AJCC-7 ; AJCC Cancer Staging Manual ; 7th edition ; CC ; colon cancer ; DSS ; disease-specific survival ; LN ; lymph node ; OS ; overall su
• 刊名：Journal of the American College of Surgeons
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：217
• 期：2
• 页码：181-190
• 全文大小：982 K

文摘

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Background

The 7th edition of the m>AJCC Cancer Staging Manualm> (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 m>AJCC Cancer Staging Manualm> (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.