A modified TNM staging system for non-metastatic colorectal cancer based on nomogram analysis of SEER database

Abstract Purpose The present study aimed to identify independent clinicopathological and socio-economic prognostic factors associated with overall survival of early-onset colorectal cancer (EO-CRC) patients and then establish and validate a prognostic nomogram for patients with EO-CRC. Methods Eligible patients with EO-CRC diagnosed from 2010 to 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into a training cohort and a testing cohort. Independent prognostic factors were obtained using univariate and multivariate Cox analyses and were used to establish a nomogram for predicting 3- and 5-year overall survival (OS). The discriminative ability and calibration of the nomogram were assessed using C-index values, AUC values, and calibration plots. Results In total, 5585 patients with EO-CRC were involved in the study. Based on the univariate and multivariate analyses, 15 independent prognostic factors were assembled into the nomogram to predict 3- and 5-year OS. The nomogram showed favorable discriminatory ability as indicated by the C-index (0.840, 95% CI 0.827–0.850), and the 3- and 5-year AUC values (0.868 and 0.84869 respectively). Calibration plots indicated optimal agreement between the nomogram-predicted survival and the actual observed survival. The results remained reproducible in the testing cohort. The C-index of the nomogram was higher than that of the TNM staging system (0.840 vs 0.804, P < 0.001). Conclusion A novel prognostic nomogram for EO-CRC patients based on independent clinicopathological and socio-economic factors was developed, which was superior to the TNM staging system. The nomogram could facilitate postoperative individual prognosis prediction and clinical decision-making.

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Key Issues in Reporting Common Cancer Specimens: Problems in Pathologic Staging of Colon Cancer

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-318-kiircc ◽

2006 ◽

Vol 130 (3) ◽

pp. 318-324 ◽

Cited By ~ 7

Author(s):

Carolyn C. Compton

Keyword(s):

Colorectal Cancer ◽

Prognostic Factor ◽

Staging System ◽

Tnm Staging ◽

International Union ◽

Cancer Resection ◽

American Joint Committee ◽

Colorectal Cancer Resection ◽

Tnm Staging System ◽

Pathologic Staging

Abstract Context.—Standardized pathologic assessment is a quality measure for cancer care. Objective.—Pathologic staging parameters and the clinically important stage-independent pathologic factors that pathologists find most problematic to evaluate in colorectal cancer resection specimens are reviewed. The objective of this review is to provide practical guidance for the practicing surgical pathologist. Data Sources.—Published literature related to the TNM staging system for colorectal cancer of the American Joint Committee on Cancer and the International Union Against Cancer and to stage-independent tissue-based prognostic factor evaluation was included in the review. Study Selection, Data Extraction, and Synthesis.—Published guidelines from authoritative sources and published peer-reviewed data related to colorectal cancer staging and pathologic prognostic factor assessment were included for consideration. The general and site-specific rules of application of the American Joint Committee on Cancer and International Union Against Cancer TNM staging system for the colorectum and the protocol for evaluation of colorectal cancer resection specimens of the Cancer Committee of the College of American Pathologists served as the basis for discussion and amplified with practical advice on specific application. Conclusions.—Standardization of pathologic evaluation of colorectal cancer resection specimens is essential for optimal patient care and is aided by the use of data-driven guidelines that are easily understood and consistently applied.

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Prognostic value of lymphovascular invasion in stage II colorectal cancer patients with an inadequate examination of lymph nodes

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02224-3 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Zhenyan Gao ◽

Huihua Cao ◽

Xiang Xu ◽

Qing Wang ◽

Yugang Wu ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Value ◽

Lymphovascular Invasion ◽

Multivariate Analyses ◽

Staging System ◽

Tnm Staging ◽

Stage Ii ◽

Tnm Staging System ◽

Serum Cea ◽

Stage Ii Colorectal Cancer

Abstract Background Lymphovascular invasion (LVI) is defined as the presence of cancer cells in lymphatics or blood vessels. This study aimed to evaluate the prognostic value of LVI in stage II colorectal cancer (CRC) patients with inadequate examination of lymph nodes (ELNs) and further combined LVI with the TNM staging system to determine the predictive efficacy for CRC prognosis. Adjuvant chemotherapy (ACT) was then evaluated for stage II CRC patients with LVI positivity (LVI+). Methods In order to avoid the effects of different ACT regimens, among 409 stage II patients, we chose 121 patients who received FOLFOX regimen and the 144 patients who did not receive ACT as the object of study. LVI was examined by hematoxylin-eosin (HE) staining. Kaplan-Meier analysis followed by a log-rank test was used to analyze survival rates. Univariate and multivariate analyses were performed using a Cox proportional hazards model. Harrell’s concordance index (C-index) was used to evaluate the accuracy of different systems in predicting prognosis. Results The LVI+ status was significantly associated with pT stage, degree of differentiation, tumor stage, serum CEA and CA19-9 levels, perineural invasion (PNI), tumor budding (TB), and KRAS status. The 5-year overall survival (OS) rate of stage II patients with < 12 ELNs and LVI+ was less than stage IIIA. Multivariate analyses showed that LVI, pT-stage, serum CEA and CA19-9 levels, PNI, TB, and KRAS status were significant prognostic factors for stage II patients with < 12 ELNs. The 8th TNM staging system combined with LVI showed a higher C-index than the 8th TNM staging system alone (C-index, 0.895 vs. 0.833). Among patients with LVI+, the ACT group had a significantly higher 5-year OS and 5-year disease-free survival (DFS) than the surgery alone (SA) group (5-year OS, 66.7% vs. 40.9%, P = 0.004; 5-year DFS, 64.1% vs. 36.3%, P = 0.002). Conclusions LVI is an independent prognostic risk factor for stage II CRC patients. Combining LVI with the 8th TNM staging system improved the predictive accuracy for CRC prognosis. ACT in stage II CRC patients with LVI+ is beneficial for survival.

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Prognostic Value of Lymphovascular Invasion in Stage Ⅱ Colorectal Cancer Patients with an Inadequate Examination of Lymph Nodes.

10.21203/rs.3.rs-150869/v1 ◽

2021 ◽

Author(s):

Zhenyan Gao ◽

Huihua Cao ◽

Xiang Xu ◽

Qing Wang ◽

Yugang Wu ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Prognostic Value ◽

Multivariate Analyses ◽

Disease Free Survival ◽

Staging System ◽

Tnm Staging ◽

Tnm Staging System ◽

Kras Status ◽

Serum Cea

Abstract BackgroundLymphovascular invasion (LVI) is defined as the existence of cancer cells in lymphatics or blood vessels. This study aimed to evaluate the prognostic value of LVI in stage Ⅱ colorectal cancer (CRC) patients with inadequate examination of lymph nodes (ELNs) and further combined LVI with the TNM staging system to determine the predictive efficacy for CRC prognosis. Adjuvant chemotherapy (ACT) was then evaluated for stage Ⅱ CRC patients with LVI positivity (LVI +).MethodsThe clinicopathologic records of 1420 CRC patients treated at the Third Affiliated Hospital of Soochow University between February 2007 and February 2013 were retrospectively reviewed. LVI was examined by hematoxylin-eosin (HE) staining. Kaplan-Meier analysis followed by a log-rank test was used to analyze survival rates. Univariate and multivariate analyses were performed using a Cox proportional hazards model. The Harrell’s concordance index (C-index) was used to evaluate the accuracy of different systems in predicting prognosis.ResultsThe LVI status was significantly associated with pT stage, degree of differentiation, tumor stage, serum CEA and CA19-9 levels, perineural invasion (PNI) and KRAS status. The 5-year overall survival (OS) rate of stage Ⅱ patients with < 12 ELNs and LVI + was less than stage ⅢA. Multivariate analyses showed that LVI, pT-stage, serum CEA and CA19-9 levels, PNI and KRAS status were significant prognostic factors for stage Ⅱ patients with < 12 ELNs. The 8th TNM staging system combined with LVI showed a higher C-index than the 8th TNM staging system alone (C-index, 0.895 vs. 0.833). Among patients with LVI + the ACT group had a significantly higher 5-year OS and 5-year disease-free survival (DFS) than the surgery alone (SA) group (5-year OS, 66.7% vs. 40.9%, P = 0.004; 5-year DFS, 64.1% vs. 36.3%, P = 0.002).ConclusionsLVI is an independent prognostic risk factor for stage Ⅱ CRC patients. Combining LVI with the 8th TNM staging system improved the predictive accuracy for CRC prognosis. ACT in stage Ⅱ CRC patients with LVI + is beneficial for survival.

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The Integration of Macroscopic Tumor Invasion of Adjacent Organs into TNM Staging System for Colorectal Cancer

PLoS ONE ◽

10.1371/journal.pone.0052269 ◽

2012 ◽

Vol 7 (12) ◽

pp. e52269 ◽

Cited By ~ 6

Author(s):

Ji-wang Liang ◽

Peng Gao ◽

Zhen-ning Wang ◽

Yong-xi Song ◽

Ying-ying Xu ◽

...

Keyword(s):

Colorectal Cancer ◽

Tumor Invasion ◽

Staging System ◽

Tnm Staging ◽

Tnm Staging System ◽

Macroscopic Tumor

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Evaluation of the Eighth Edition of the American Joint Committee on Cancer TNM Staging System for Gastric Cancer: An Analysis of 7371 Patients in the SEER Database

Gastroenterology Research and Practice ◽

10.1155/2019/6294382 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Long-Long Cao ◽

Jun Lu ◽

Ping Li ◽

Jian-Wei Xie ◽

Jia-Bin Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rates ◽

Stage Iv ◽

Staging System ◽

Tnm Staging ◽

Stage Migration ◽

Seer Database ◽

Tnm System ◽

American Joint Committee ◽

Tnm Staging System

Objective. To investigate the validity of the 8thedition of the American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer.Methods. The clinicopathologic data of 7371 patients who were diagnosed with gastric cancer and had 16 or more involved lymph nodes (LNs) were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and retrospectively reviewed.Results. Stage migration occurred primarily during stage III between the 7thand 8thedition TNM staging systems. Stages IIIB and IIIC in the 7thedition staging system were divided in the 8thedition and had obvious differences in survival rates (bothP<0.001). The 8thedition TNM stages IIIC and IV showed similar survival rates (P=0.101). The prognosis of patients with T4aN3bM0 was not different from that of patients with TxNxM1 (P=0.433), while the prognosis of patients with T4bN3bM0 was significantly poorer than that of patients with TxNxM1 (P=0.008). A revised TNM system with both T4aN3bM0 and T4bN3bM0 incorporated into stage IV was proposed. Multivariable regression analysis showed that the revised TNM system, but not the 7thand 8theditions, was an independent factor for disease-specific survival (DSS) in the third step of the analysis. Further analyses revealed that the revised TNM system had superior discriminatory ability to the 8thedition staging system, which was also an improvement over the 7thedition staging system.Conclusion. The 8thedition of the AJCC TNM staging system is superior to the 7thedition for predicting the DSS rates of gastric cancer patients. However, for better prognostic stratification, it might be more suitable for T4aN3bM0/T4bN3bM0 to be incorporated into stage IV in the 8thedition TNM staging system.

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