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Comparison of model fit and discriminatory ability of the 8th edition of the tumor-node-metastasis classification and the 9th edition of the Japanese classification to identify stage III colorectal cancer

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Abstract

Background

The most widely accepted staging system for colorectal cancer (CRC) is the tumor-node-metastasis (TNM) classification. In Japan, the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (JCCRC) system is used. The two systems differ mainly in relation to tumor deposits (TD) and metastasis in the regional lymph nodes along the main feeding arteries and lateral pelvic lymph nodes (N3). Here, we investigated the prognostic ability of the two systems for stage III CRC.

Methods

We reviewed 696 consecutive patients who underwent curative resection of stage III CRC at the National Cancer Center Hospital between May 2007 and April 2014. We examined the clinicopathological features of CRC and predicted overall survival (OS) and relapse-free survival (RFS) according to the 8th TNM and 9th JCCRC systems. The systems were compared using Akaike’s information criterion (AIC), Harrell’s concordance index (C-index), and time-dependent receiver-operating characteristic (ROC) curves.

Results

The 9th JCCRC system was more clinically effective according to AIC (OS, 1199 vs. 1206; RFS, 2047 vs. 2057), showed better discriminatory ability according to the C-index (OS, 0.65 vs. 0.62; RFS, 0.62 vs. 0.58), and its time-dependent ROC curve was superior compared with the 8th TNM system.

Conclusion

These results suggest that the 9th JCCRC system has superior discriminative ability to the 8th TNM system, because the 9th JCCRC accounts for the presence of TD and N3 disease, which were both significant predictors of poor prognosis. Reconsidering the clinical value of these two factors in the TNM system could improve its clinical significance.

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Abbreviations

AIC:

Akaike’s information criterion

AUC:

Area under the curve

CRC:

Colorectal cancer

EX:

Extramural cancer deposits without lymph node structure

JCCRC:

Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma

JSCCR:

Japanese Society for Cancer of the Colon and Rectum

LLNM:

Lateral pelvic lymph node metastasis

LPLN:

Lateral pelvic lymph node

MLN:

Main lymph node

MLNM:

Main lymph node metastasis

ND:

Tumor nodules

OS:

Overall survival

RFS:

Relapse-free survival

ROC:

Receiver-operating characteristic

TD:

Tumor deposits

TNM:

Tumor-node-metastasis

UICC:

Union for International Cancer Control

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Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Kei Kitamura, Dai Shida, Yuka Ahiko, Yuya Nakamura, Konosuke Moritani, Shunsuke Tsukamoto & Yukihide Kanemitsu

  2. Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan

    Dai Shida & Yuka Ahiko

  3. Molecular Pathology Division, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Shigeki Sekine

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  1. Kei Kitamura
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Correspondence to Dai Shida.

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Kitamura, K., Shida, D., Sekine, S. et al. Comparison of model fit and discriminatory ability of the 8th edition of the tumor-node-metastasis classification and the 9th edition of the Japanese classification to identify stage III colorectal cancer. Int J Clin Oncol 26, 1671–1678 (2021). https://doi.org/10.1007/s10147-021-01955-3

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