Optimal Colorectal Cancer Staging Criteria in TNM Classification

被引：90

作者：

Ueno, Hideki ^{[1
]}

Mochizuki, Hidetaka

Akagi, Yoshito ^{[2
]}

Kusumi, Takaya ^{[3
]}

Yamada, Kazutaka ^{[4
]}

Ikegami, Masahiro ^{[5
]}

Kawachi, Hiroshi ^{[6
]}

Kameoka, Shingo ^{[7
]}

Ohkura, Yasuo ^{[8
]}

Masaki, Tadahiko ^{[8
]}

Kushima, Ryoji ^{[12
]}

Takahashi, Keiichi ^{[9
]}

Ajioka, Yoichi ^{[13
]}

Hase, Kazuo ^{[10
]}

Ochiai, Atsushi ^{[14
]}

Wada, Ryo ^{[15
]}

Iwaya, Keiichi ^{[16
]}

Shimazaki, Hideyuki

Nakamura, Takahiro ^{[11
]}

Sugihara, Kenichi ^{[6
]}

机构：

[1] Natl Def Med Coll, Dept Surg, Tokorozawa, Saitama 3598513, Japan

[2] Kurume Univ, Fac Med, Kurume, Fukuoka 830, Japan

[3] Keiyukai Sapporo Hosp, Sapporo, Hokkaido, Japan

[4] Takano Hosp, Kumamoto, Japan

[5] Jikei Univ, Sch Med, Tokyo, Japan

[6] Tokyo Med & Dent Univ, Tokyo, Japan

[7] Tokyo Womens Med Univ, Tokyo, Japan

[8] Kyorin Univ, Tokyo, Japan

[9] Tokyo Metropolitan Komagome Hosp, Tokyo, Japan

[10] Self Def Forces Cent Hosp, Tokyo, Japan

[11] RIKEN, Ctr Genom Med, Tokyo, Japan

[12] Shiga Univ Med Sci Hosp, Otsu, Shiga, Japan

[13] Niigata Univ, Niigata, Japan

[14] Natl Canc Ctr Hosp E, Kashiwa, Chiba, Japan

[15] Juntendo Univ, Sch Med, Juntendo Shizuoka Hosp, Shizuoka, Japan

[16] Tokyo Med Univ, Kasumigaura Hosp, Ibaraki, Japan

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2012年 / 30卷 / 13期

关键词：

PERICOLONIC TUMOR DEPOSITS; EVIDENCE-BASED MEDICINE; PATHOLOGICAL ASSESSMENT; SET STANDARDS; RECTAL-CANCER; MESORECTUM; SPREAD; TIME; PROGNOSIS; NODULES;

D O I：

10.1200/JCO.2011.39.4692

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose Histologic components of the TNM classification system have been repeatedly revised since the fifth edition (TNM5). TNM classification revisions provide different criteria for categorizing tumor nodules without residual lymph node structure (ND). However, there are few systematic evaluations regarding the effectiveness of these revisions. Patients and Methods A multicenter pathologic review for ND in colorectal cancer (CRC) was performed. Tumor staging defined by TNM5, sixth edition (TNM6), and seventh edition (TNM7) were compared on the basis of Akaike information criterion (AIC) and Harrell's concordance index (c-index). Moreover, TNM7's prognostic value was compared between the original ND and modified criteria, which considered all regional NDs as lymph node metastasis (LNM) irrespective of the original structure. Results In 1,716 treated patients with CRC (1994 to 1998), tumor stages (I/II/III) exhibited better prognoses in TNM7 (AIC, 3055.1; c-index, 0.7215) than in TNM6 (AIC, 3063.7; c-index, 0.7149), but not better than in TNM5 (AIC, 3051.6; c-index, 0.7240). Comparing the original TNM7 and modified criteria, 4.2% of patients were classified in different N stages (N0/N1/N2a/N2b); both AIC and the c-index were superior in the modified criteria (AIC, 3029.40; c-index, 0.7271) compared with the original criteria (AIC, 3040.58; c-index, 0.7230). Modified criteria were also associated with improved prognostic power of tumor stages (I/IIA/IIB/IIC/IIIA/IIIB/IIIC). These results were similar in another cohort of 2,242 treated patients with CRC (1999 to 2003). Conclusion 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.

引用

页码：1519 / 1526

页数：8

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