Lack of Hierarchical Survival Prognosis in AJCC Staging for Colon and Rectal Cancer—Implications for Future Summary Stage Classification

IF 3.3 3区 医学 Q2 ONCOLOGY
Neal Bhutiani MD, PhD , Chung-Yuan Hu MPH, PhD , Bryan Palis MS , Joseph Cotler MA, PhD , Qian Shi PhD , M. Kay Washington MD , Richard M. Goldberg MD , Scott R. Steele MD, MBA , George J. Chang MD, MS, MHCM
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引用次数: 0

Abstract

Background

Current American Joint Committee on Cancer (AJCC) staging for colorectal cancer utilizes TNM framework groups disease based on extent and provides prognostic information, ideally with a hierarchical logic. We sought to evaluate survival as a function of stage within the 8th edition AJCC staging system for colon and rectal cancer.

Methods

Patients with primary colon or rectal cancer diagnosed 2010-2016 were identified from the National Cancer Database (NCDB). Survival curves were used to determine staging hierarchy for colon and rectal cancer. Multivariable modeling was used to identify relative contributions of variables (z-score) to survival, and hazard ratio (HR)-based groupings were constructed.

Results

Among 270,584 colon and 53,846 rectal cancer patients, AJCC summary staging was non-hierarchical (e.g. HR IIC=2.92, HR IIIA=0.85-1.31). Multivariable analysis demonstrated high T category (T4a, T4b) confers the greatest mortality (colon: T4a HR 2.76, T4b HR 3.04; rectum: T4a HR 3.29, T4b HR 3.73), while high T category as well as high N category (colon: T4a z=66.9, T4b z=64.6, N2b z=55.7; rectum: T4b z=31.1, N2b z=25.1) contributed substantially to the survival model. HR based TN groupings resulted in hierarchical stage organization.

Conclusions

Current AJCC stage groups for colorectal cancer are non-hierarchical. High T category has a greater impact on survival than N category for patients with early N disease, while high N category was more important for patients with early T disease. An organizational framework based on HR groupings is hierarchical and provides more accurate prognostic information.
结肠癌和直肠癌AJCC分期缺乏分级生存预后对未来总结分期的影响。
背景:目前美国癌症联合委员会(AJCC)对结直肠癌的分期采用TNM框架根据程度对疾病进行分组,并提供预后信息,理想情况下采用分层逻辑。我们试图在第8版AJCC结肠癌和直肠癌分期系统中评估生存率作为分期的功能。方法:从国家癌症数据库(NCDB)中识别2010-2016年诊断为原发性结肠癌或直肠癌的患者。生存曲线用于确定结肠癌和直肠癌的分期等级。使用多变量建模来确定变量(z-score)对生存率的相对贡献,并构建基于风险比(HR)的分组。结果:在270,584例结肠癌和53,846例直肠癌患者中,AJCC的总分期是非分层的(如HR IIC=2.92, HR IIIA=0.85-1.31)。多变量分析显示,高T型(T4a, T4b)死亡率最高(结肠:T4a HR 2.76, T4b HR 3.04;直肠:T4a HR 3.29, T4b HR 3.73),高T类和高N类(结肠:T4a z=66.9, T4b z=64.6, N2b z=55.7;直肠:T4b z=31.1, N2b z=25.1)对生存模型有重要贡献。基于人力资源的TN分组导致分层阶段组织。结论:目前AJCC对结直肠癌的分期是无等级的。对于早期T病患者,高T分型对生存的影响大于N分型,而对于早期T病患者,高N分型更重要。基于人力资源分组的组织框架是分层的,并提供更准确的预测信息。
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来源期刊
Clinical colorectal cancer
Clinical colorectal cancer 医学-肿瘤学
CiteScore
5.50
自引率
2.90%
发文量
64
审稿时长
27 days
期刊介绍: Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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