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Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification

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Abstract

Purpose

The 9th Japanese Classification of Colorectal Cancer (9th JSCCR) has two main differences from the TNM classification (8th AJCC): first, main or lateral lymph node metastasis is classified as jN3; second, tumor nodules (ND) are treated as lymph node metastasis. In this study, we verified the 9th JSCCR for rectal cancer, focusing on the differences with the 8th AJCC.

Methods

This retrospective analysis involved 212 patients with stage I-III rectal cancer. ND was evaluated using whole-mount sections. We evaluated the relapse-free survival of each staging system, and compared the prognostic significance of the different staging systems using the Akaike information criterion (AIC) and Harrell’s concordance index (c-index).

Results

Main or lateral lymph node metastasis was detected in nine of 212 (4%) patients. ND was detected in 79 of 212 (37%) patients. The best risk stratification power was observed in the 9th JSCCR (AIC, 759; c-index, 0.708) compared with the 7th JSCCR (AIC, 771; c-index, 0.681), 8th JSCCR (AIC, 768; c-index, 0.696), and the 8th AJCC (AIC, 766; c-index, 0.691).

Conclusions

The 9th JSCCR, which includes the concepts of jN3 and ND, is useful for the risk stratification of rectal cancer, and the contributes to precise decision-making for follow-up management and adjuvant therapy.

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan

    Michiru Arabiki, Yoshifumi Shimada, Mae Nakano, Kana Tanaka, Hidehito Oyanagi, Masato Nakano & Toshifumi Wakai

  2. Division of Bioinformatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Yiwei Ling & Shujiro Okuda

  3. Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan

    Yasumasa Takii

Authors
  1. Michiru Arabiki
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  2. Yoshifumi Shimada
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  3. Mae Nakano
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  4. Kana Tanaka
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  5. Hidehito Oyanagi
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  9. Yasumasa Takii
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Correspondence to Yoshifumi Shimada.

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Arabiki, M., Shimada, Y., Nakano, M. et al. Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification. Surg Today 50, 1443–1451 (2020). https://doi.org/10.1007/s00595-020-02024-4

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  • DOI: https://doi.org/10.1007/s00595-020-02024-4

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