Abstract
Purpose
According to the American Joint Committee on Cancer (AJCC) 7th edition, T4 colon cancers have been sub-divided into T4a and T4b, resulting in a stage II sub-classification (T3N0, T4aN0, and T4bN0). This study was aimed: (a) to investigate the impact of the AJCC 7th edition stage II sub-classification on the overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) of colon cancer patients who underwent surgical resection and (b) to compare the last three AJCC editions for identifying stage II patients with high-risk of progression.
Methods
One hundred seventy-eight stage II colon cancers out of 682 colorectal cancer patients who underwent surgical resection were selected. T4N0 were sub-divided in accordance with the AJCC 7th edition. Mean follow-up was 41.9 months. Kaplan–Meier method was employed to estimate the survival curves.
Results
OS analysis documented a significant difference between stage-sub-groups using the 6th edition; conversely, this difference was not seen if the 7th edition was applied (p = 0.03 and 0.12, respectively). Stage II DFS analysis reported a significant difference using both the AJCC 6th and 7th editions (p = 0.03 and 0.02, respectively). A significant difference was reported on stage II DSS analysis using the AJCC 6th edition (p = 0.03); however, when the 7th edition was applied, a substantial discrepancy between survival curves was noted with T3N0 and T4aN0 displaying similar outcomes (p = 0.006).
Conclusions
The AJCC 7th edition is a reliable classification that might implement the identification of those stage II colon cancer patients with high-risk of progression, recurrence, and cancer mortality.
Similar content being viewed by others
References
American Joint Committee on Cancer (1977) Manual for staging of cancer, 1st edn. American Joint Committee on Cancer, Chicago
TNM Classification of malignant tumors, 2nd edition; International Union Against Cancer, 3 rue du Conseil-General, 1205 Geneva, Switzerland
American Joint Committee on Cancer (1983) Manual for staging of cancer, 2nd edn. Lippincott, Philadelphia
American Joint Committee on Cancer (1988) Manual for staging of cancer, 3rd edn. Lippincott, Philadelphia
American Joint Committee on Cancer (1997) Manual for staging of cancer, 5th edn. Lippincott, Philadelphia
American Joint Committee on Cancer (2002) Manual for staging of cancer, 6th edn. Springer, Berlin
Colorectal Working Group, Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP (2000) American Joint Committee on Cancer prognostic factors consensus conference. Cancer 88(7):1739–1757
Sheperd N, Baxter K, Love S (1997) The prognostic importance of peritoneal involvement in colonic cancer: a prospective evaluation. Gastroenterology 112:1096–1102
Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK (2009) Revised TN categorization for colon cancer based on national survival outcome data. J Clin Oncol 28(2):264–271
Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK (2009) Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology and end result and rectal pooled analysis outcomes. J Clin Oncol 28(2):256–263
American Joint Committee on Cancer (2009) Manual for staging of cancer, 7th edn. Springer, Berlin
Gunderson LL, Sargent DJ, Tepper JE, O’Connel MJ, Allmer C, Smalley SR, Martenson JA, Haller DG, Mayer RJ, Rich TA, Ajani JA, Macdonald JS, Goldberg RM (2002) Impact of T and N substage on survival and disease relapse in adjuvant rectal cancer: a pooled analysis. Int J Radiat Oncol Biol Phys 54(2):386–396
Gunderson LL, Sargent DJ, Tepper JE, Wolmark N, O’Connell MJ, Begovic M, Allmer C, Colangelo L, Smalley SR, Haller DG, Martenson JA, Mayer RJ, Rich TA, Ajani JA, Macdonald JS, Willett CG, Goldberg RM (2004) Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol 22(10):1785–1796
Gollis S (2010) Radiotherapy, chemotherapy and biological therapy in the curative treatment of locally advantage rectal cancer. Color Dis 12(Supp 2):2–24
Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A (1998) Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 41(9):1127–1133
Rodriguez-Moranta F, Salo J, Arcusa A, Boadas J, Piñol V, Bessa X, Batiste-Alentorn E, Lacy AM, Delgado S, Maurel J, Piqué JM, Castells A (2006) Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol 24(3):386–393
Secco GB, Fardelli R, Gianquinto D, Bonfante P, Baldi E, Ravera G, Derchi L, Ferraris R (2002) Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol 28(4):418–423
Swamy R (2010) Histopathological reporting of pT4 tumor stage in colorectal carcinomas: dotting the ‘i’s and crossing the ‘t’s. J Clin Pathol 63:110–115
National Comprehensive Cancer Network (NCCN) Clinical practice guidelines in oncology (NCCN Guidelines™). Colon Cancer. Version 3.2011. Available from: http//:www.nccn.org
Benson AB, Shrag D, Somerfield MR, Cohen AM, Figuredo AT, Flynn PJ, Kryzanowska MK, Maroun J, McAllister P, Van Custem E, Brouwers M, Charette M, Haller DG (2004) American Society of Clinical Oncology Recommendations on adjuvant Chemotherapy for Stage II colon cancer. J Clin Oncol 22(16):3408–3419
Gill S, Loprizi CL, Sargent DJ, Thomè SD, Alberts SR, Haller DG, Benedetti J, Francini G, Shepherd LE, Seitz JF, Labianca R, Chen W, Cha SS, Heldebrant MP, Goldberg RM (2004) Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 22(10):1797–1806
Greene FL, Stewart AK, Norton J (2002) A new TNM staging strategy for node-positive (stage III) colon cancer. An analysis of 50.042 patients. Ann Surg 236(4):416–421
Saergent D, Sobrero A, Grothey A, O’Connell MJ, Buyse M, Andre T, Zheng Y, Green Em Labianca R, O’Callaghan C, Seitz JF, Francini G, Haller D, Yothers G, Goldeberg R, de Gramont A (2009) Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 27(6):872–877
Funding
Laura Lorenzon and Marco La Torre are supported by the Ph.D. University Grant program “Clinical and Experimental Research Methodologies in Oncology” provided by the Faculty of Medicine and Psychology University of Rome “La Sapienza.”
Competing interests
None of the authors have any potential financial conflict of interest related to this manuscript.
Author information
Authors and Affiliations
Corresponding author
Additional information
Authorship: all authors contributed in preparing the manuscript; all authors have reviewed and approved the manuscript in its final form.
Rights and permissions
About this article
Cite this article
Lorenzon, L., Pilozzi, E., La Torre, M. et al. Impact and prognostic implications of colon cancers stage II sub-classification through the years. Int J Colorectal Dis 27, 1311–1318 (2012). https://doi.org/10.1007/s00384-012-1475-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-012-1475-x