Optimal Colorectal Cancer Staging Criteria in TNM Classification

Ueno, Hideki; Mochizuki, Hidetaka; Akagi, Yoshito; Kusumi, Takaya; Yamada, Kazutaka; Ikegami, Machiko; Kawachi, Hiroshi; Kameoka, Shingo; Ohkura, Yasuo; Terabe, Masaki; Kushima, Ryoji; Takahashi, Keiichi; Ajioka, Yoichi; Hase, Kazuo; Ochiai, Atsushi; Wada, Ryo; Iwaya, Keiichi; Shimazaki, Hideyuki; Nakamura, Takahiro; Sugihara, Kenichi

doi:10.1200/jco.2011.39.4692

Cited by 87 publications

(82 citation statements)

References 21 publications

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“…In the present study, we used a C-index calculated on the basis of timedependent ROC curve analysis to quantify the ability to predict survival time in absolute values. There have been reports on scientific, objective C-index-based evaluations of the staging system in terms of the predictive ability for survival outcomes in colorectal cancer and endocrine cell cancer [15,16]; however, no similar reports have been published related to gastric cancer. In the present study, the C-index exceeded 0.7, which is the threshold for moderate predictive ability, even when based on either cT or cN alone.…”

Section: Discussionmentioning

confidence: 99%

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Impact of clinical tumor–node–metastasis staging on survival in gastric carcinoma patients receiving surgery

et al. 2016

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Background Preoperative clinical staging of gastric cancer is used to determine therapeutic strategies. However, the impact of the clinical stage on survival has not been completely investigated, although the relationship between pathologic staging and survival outcome has been reported. The aim of the present study was to clarify the predictability of patient survival based on clinical staging and to evaluate the usefulness of staging as an indicator for selecting the treatment modality. Methods A total of 3033 patients who underwent surgery for gastric cancer were included. A survival analysis was conducted based on the seventh edition of the tumor-nodemetastasis (TNM) clinical staging system of the American Joint Committee on Cancer. The predictive ability of the TNM clinical stage for survival was evaluated by Harrell's C-index, a measure of the separation of survival distributions.Results The cumulative 5-year survival rates according to the clinical stage were 94.3 % (IA), 84.7 % (IB), 71.7 % (IIA), 56.1 % (IIB), 55.7 % (IIIA), 42.3 % (IIIB), 22.8 % (IIIC), and 9.1 % (IV). Although no significant difference was observed between clinical stages IIB and IIIA (p = 0.865), significant differences existed between all other clinical stages (p \ 0.001). Harrell's C-index applied to these results was 0.825 (95 % confidence interval 0.819-0.831). Conclusions The seventh edition of the TNM clinical staging system has a strong prognostic ability with a satisfactory C-index and should be considered valuable for selecting therapeutic strategies for the treatment of gastric cancer.

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Section: Discussionmentioning

confidence: 99%

“…Reports on objective C-index-based evaluation are available for other cancers [15,16] but not for gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

Impact of clinical tumor–node–metastasis staging on survival in gastric carcinoma patients receiving surgery

et al. 2016

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“…In addition, we observed that subdivisions A and B in the stages II and III of the 7th edition do not translate into different prognosis. As a result, the discriminatory indexes were found to be disappointing, similar to those published in colorectal cancer [29]. Recently Sano et al [30] suggested a new staging grouping launched by the International Gastric Cancer Association (IGCA), in which the introduction of pN3a and pN3b subclassification resulted in better stratification especially among stage III subgroups.…”

Section: Os Kiel Protocolmentioning

confidence: 86%

External Validation of the Proposed Kiel Staging System and Comparison with the Old (6th Edition) and the Currently Used (7th Edition) TNM Classification in Gastric Cancer

et al. 2018

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Background: Despite the announcement of the 8th edition of TNM classification, the 7th edition (2010) is still being used for prognostic assessment in gastric cancer patients. A proposed new staging system (termed as the Kiel proposal) claims to offer a better prognostic stratification. Our objective was to retrospectively evaluate the Kiel proposal and compare it with the 6th and 7th TNM editions on a collected database. Methods: We retrospectively analyzed gastric cancer patients who had undergone surgical resection without any previous treatment from selected randomized trials and from a cohort of patients operated at the University Hospital of Mainz, Germany. All patients were restaged using the 3 staging systems and overall survival was estimated and compared. Results: A study population of 491 patients was identified. Relevant changes in stage distribution between the 6th and 7th TNM and the Kiel staging systems were observed. The 6th classification appears to display the best discriminatory measures. The Kiel staging system is slightly less prognostic than the TNM editions, but provides clearly separated strata as with the 6th edition. Conclusions: The Kiel staging system for gastric cancer appears promising in terms of simplicity, predictability and applicability and should be taken into consideration in future TNM revisions.

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“…Tumor biological factors, which constitute the tumor-node-metastasis (TNM) stage, were enacted by the American Joint Committee on Cancer (AJCC) and have been validated as indicators to evaluate CRC prognosis before patients undergo treatment [4]. However, the current TNM stage system for CRC lacks information reflecting the inflammatory status in patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of the Glasgow Prognostic Score or Modified Glasgow Prognostic Score for Patients with Colorectal Cancer Receiving Various Treatments: a Systematic Review and Meta-Analysis

He¹,

Li²,

Cai³

et al. 2018

Cell Physiol Biochem

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Background/Aims: Increasing evidence indicates that the systemic inflammatory response plays a vital role in carcinogenesis. The Glasgow Prognostic Score or modified Glasgow Prognostic Score (GPS/mGPS) is a novel inflammatory indicator which consists of CRP and albumin. Here, we performed a meta-analysis to evaluate the prognostic value of the GPS/ mGPS in patients with colorectal cancer (CRC) and to assess its consistency in different CRC therapies. Methods: The electronic databases PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched from inception through December 2017 for the association between the GPS/mGPS and clinical outcomes. Study characteristics and prognostic data were extracted from each relevant study. Overall survival (OS) and cancer-specific survival (CSS) were considered the primary outcomes, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. The quality of each study was pooled using the random-effects Mantel-Haenszel model. Finally, subgroup analyses were performed to detect the heterogeneity of different CRC treatments. Results: Thirty-four studies, with a combined total of 8834 patients, were eligible for this meta-analysis. Data on OS and CSS were available in 23 and 22 studies, respectively. By comparing the prognostic values of different levels of the GPS in CRC patients, the summary HRs for OS and CSS were 2.18 (95% CI 1.83-2.60) and 1.82 (95% CI 1.57-2.11), respectively. According to the different tumor stages, the subgroup analyses were stratified by different treatments, including curative or palliative therapy. The results robustly confirmed the prognostic role of the GPS/mGPS. Conclusion: Our results suggest that the GPS/mGPS is a novel and effective prognostic indicator for the OS and CSS of patients with CRC.

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Optimal Colorectal Cancer Staging Criteria in TNM Classification

Abstract: The prognostic value of TNM7 is better than that of TNM6; however, improvement over TNM5 is insignificant. By considering all regional NDs as LNM irrespective of their morphology, TNM classification can be simplified and its prognostic value improved.

Cited by 87 publications

References 21 publications

Impact of clinical tumor–node–metastasis staging on survival in gastric carcinoma patients receiving surgery

Impact of clinical tumor–node–metastasis staging on survival in gastric carcinoma patients receiving surgery

External Validation of the Proposed Kiel Staging System and Comparison with the Old (6th Edition) and the Currently Used (7th Edition) TNM Classification in Gastric Cancer

Prognostic Value of the Glasgow Prognostic Score or Modified Glasgow Prognostic Score for Patients with Colorectal Cancer Receiving Various Treatments: a Systematic Review and Meta-Analysis

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