Summary
After a chronological overview of the various staging systems for colorectal cancer, presented in an effort to demonstrate the reasons for the current state of confusion, four different systems (Dukes. Astler and Coller, ACPS, TNM) were compared in 791 patients treated at some stage of their disease at Parma University’s Institute of Surgery. Life survival table analysis was used to examine survival according to each staging system. From the analysis of the staging systems commonly utilised, Dukes’system modified by Astler and Coller, emerges as the best reference model now available. The system can be fine-tuned to a certain extent, in order to improve its predictive value, by taking into account the number of lymph nodes affected by the tumour; further improvement is also foreseeable, above all by the use of genetic variables. However, no classification system can be correct, if it is not accompanied by an accurate pre-operative diagnosis and a thorough post-operative histological study.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Lockhart-Mummery JP. Two hundred cases of cancer of the rectum treated by perineal excision. Br J Surg 1926; 14: 110–117.
Dukes C. The classification of cancer of the rectum. Pathol Bacteriol 1932; 35: 323–337.
Deans GT, Patterson CC, Parks TG, Spence RA, Heatley M, Moorehead RJ, Rowlands BJ. Colorectal carcinoma: importance of clinical and pathological factors in survival. Ann R Coll Surg Engl 1994; 76: 59–64.
Ropponen K, Eskelinen M, Kosma VM, Lipponen P, Paakkinen P, Alhava E. Comparison of classic and quantitative prognostic factors in colorectal cancer. Anticancer Res 1996; 16: 3875–3882.
Hannisdal E, Thorsen G. Regression analysis of prognostic factors in colorectal cancer. J Surg Oncol 1988; 37: 109–112.
Astler WB, Coller FA. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954; 139: 846–852.
Jass JR. Future role of the pathologist in reporting colorectal cancer. World J Surg 1997; 21: 688–693.
Nathanson SD. Is there a role for clinical prognostic factors in staging patients with colorectal cancer?. Semin Surg Oncol 1994; 10: 176–182.
Crucitti F, Sofo L, Doglietto GB, Bellantone R, Ratto C, Bossola M, Crucitti. A Prognostic factors in colorectal cancer: current status and new trends. J Surg Oncol(suppl) 1991; 2: 76–82.
Tumbull RB Jr. The no touch isolation technique of resection. JAMA 1975; 231: 1181–1187.
Tumbull RB Jr, Kyle K, Watson FR, Spratt J. Cancer of the colon: the influence of the no touch isolation technique on survival rates. Ann Surg 1967; 166: 420–425.
International Union Against Cancer. TNM: Illustrated guide to the classification of malignant tumors. Geneva, 1978.
American Joint Committee for Cancer Staging and End-Results Reporting: Manual for staging of cancer. Chicago, 1978.
D’eredita G, Serio G, Neri V, Polizzzi RA, Barberio G, Losacco T. A survival regression analysis of prognostic factors in colorectal cancer. Aust N Z J Surg 1996; 66: 445–451.
Gasser A, Isaak B, Maibach R, Ruchti C, Wagner HE, Nothiger F. Staging and prognosis of colorectal carcinoma. Schweiz Med Wochenschr 1992; 122: 1356–1362.
Williams ST, Beart RW Jr. Staging of colorectal cancer. Semin Surg Oncol 1992; 8: 89–93
Jass JR. Staging of colorectal cancer (symposium). Int J Colorectal Dis 1987; 2: 123–128.
Newland RC, Chapuis PH, Pheils MT, McPherson JG. The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases. Cancer 1981; 47: 1424–1429.
Davis NC, Newland RC. Terminology and classification of colorectal adenocarcinoma: The Australian Clinico-Pathologic System. Aust NZ J Surg 1983; 53: 211–215.
Payne JE. International colorectal carcinoma staging and grading. Dis Colon Rectum 1989; 32: 282–286.
Jass JR, Love SB, Northover JMA. A new prognostic classification of rectal cancer. Lancet 1987; 1: 1303–1305.
Secco GB, Fardelli R, La Pertosa G. Valore prognostico della classificazione di Jass nel cancro del colon sinistro e del retto. Minerva Chir 1990; 45: 1347–1354.
Pietra N, Sarli L, Thenasseril B, Costi R, Cattaneo G, Gobbi S, Peracchia A. Risk factors for local recurrence of colorectal cancer: a multivariate study. Br J Surg 1997; 84: 63 (abstr.).
Deans GT, Parks TG, Rowlands BJ, Spence RA Prognostic factors in colorectal cancer. Br J Surg 1992; 79: 608–613.
Chapui PH, Fisher R, Dent OF, Newland RC, Pheil MT. The relationship between different staging methods and survival in colorectal carcinoma. Dis Colon Rectum 1985; 28: 158–161.
Yasui K, Hirai T, Kato T, Torii A, Uesaka K, Morimoto T, Kodera Y, Yamamura Y, Kito T, Hamajima N. A new macroscopic classification predicts prognosis for patients with liver metastases
from colorectal cancer. Ann Surg 1997; 226: 582–586.
Gabriel WB, Dukes C, Bussey H. Lymphatic spread in cancer of the rectum. Br J Surg 1935; 23: 395–400.
Mainprize KS, McC Mortensen NJ, Warren BF. Early colorectal cancer: recognition, classification and treatment. Br J Surg 1998; 85: 469–476.
Hyder JW, Talbott TM, Maycroft TC. A Critical review of chemical lymph node clearance and staging of colon and rectal cancer at Ferguson Hospital, 1977 to 1982. Dis Colon Rectum 1990; 33: 923–925.
Pinto AE, Chaves P, Fidalgo P, Oliveira AG, Leitao CN, Soares J. Flow cytometric DNA ploidy and S-phase fraction correlate with histopathologic indicators of tumor behavior in colorectal carcinoma. Dis Colon Rectum 1997; 40: 411–419.
Pietra N, Sarli L, Sansebastiano G, Saccani Jotti G, Peracchia A. Prognostic value of ploidy, cell proliferation kinetics, and conventional clinicopathologic criteria in patients with colorectal carcinoma. A prospective study. Dis Colon Rectum 1996; 39: 494–503.
Ropponen KM, Eskelinen MJ, Lipponen PK, Alhava E, Kosma VM. Prognostic value of tumourinfiltrating lymphocytes (TILs) in colorectal cancer. J Pathol 1997; 182: 318–324.
Leen E, Angerson WG, Cooke TG, McArdle CS. Prognostic power of Doppler perfusion index in colorectal cancer. Correlation with survival. Ann Surg 1996; 223: 199–203.
Ropponen K, Eskelinen M, Kosma VM, Lipponen P, Paakkinen P, Alhava E. Comparison of classic and quantitative prognostic factors in colorectal cancer. Anticancer Res 1996; 16: 3875–3882.
Senagore AJ, Biener JT. A newly identified pattern of K-ras mutations at codons 12 and 13 is associated with long-term survival in colorectal cancer. Surgery 1997; 122: 765–770.
Kapitanovic S, Radosevic S, Kapitanovic M, Andelinovic S, Ferencic Z, Tavassoli M, Primorac D, Sonicki Z, Spaenti S, Pavelic K, Spaventi R. The expression of p185 (HER-2/neu) correlates with the stage of disease and survival in colorectal cancer. Gastroenterology 1997; 21: 1103–1113.
Bosman FT. Prognostic value of pathological characteristics of colorectal cancer. Eur J Cancer 1995; 31: 1216–12121.
Jass JR. Future role of the pathologist in reporting colorectal cancer. World J Surg 1997; 21: 688–693.
Sarli L, Pietra N, Carreras F, Longinotti M, Gafa M, Peracchia A. Metastasi epatiche occulte da carcinoma colo-rettale: considerazioni diagnostiche e prognostiche. Giorn Chir 1991; 12: 232–236.
Blenkinshop WK, Stewart-Brown S, Blesovsky L. Histopathology reporting in large bowel cancer. J Clin Pathol 1981; 34: 598–603.
Wolmark N, Fisher B, Wieand HS. The prognostic value of the modification of the Dukes’ C Class of colorectal cancer. Ann Surg 1986; 203: 115–119.
Compton CC, Henson DE, Hutter RV, Sobin LH, Bowman HE. Updated protocol for the examination of specimens removed from patients with colorectal carcinoma. A basis for checklists. Arch Pathol Lab Med 1991; 121: 1247–1254.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1999 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Peracchia, A., Sarli, L., Pietra, N., Gobbi, S. (1999). A critical review of classification systems for colorectal cancer. In: Zanella, E. (eds) Advances in Abdominal Surgery. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4469-8_10
Download citation
DOI: https://doi.org/10.1007/978-94-011-4469-8_10
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-010-5914-5
Online ISBN: 978-94-011-4469-8
eBook Packages: Springer Book Archive