A Modified Tumor-Node-Metastasis Classification for Primary Operable Colorectal Cancer

Author:

Zhang Chundong12ORCID,Mei Zubing34,Pei Junpeng1,Abe Masanobu5,Zeng Xiantao67,Huang Qiao67,Nishiyama Kazuhiro8,Akimoto Naohiko9ORCID,Haruki Koichiro9ORCID,Nan Hongmei1011,Meyerhardt Jeffrey A12ORCID,Zhang Rui13,Li Xinxiang1415,Ogino Shuji9161718ORCID,Ugai Tomotaka916ORCID

Affiliation:

1. Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China

2. Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

3. Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

4. Anorectal Disease Institute of Shuguang Hospital, Shanghai, China

5. Division for Health Service Promotion, University of Tokyo, Tokyo, Japan

6. Center for Evidence-based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China

7. Department of Evidence-based Medicine and Clinical Epidemiology, The Second Clinical College of Wuhan University, Wuhan, China

8. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

9. Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

10. Department of Global Health, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA

11. Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA

12. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

13. Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China

14. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

15. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

16. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

17. Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA

18. Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA

Abstract

Abstract Background The American Joint Committee on Cancer (AJCC) 8th tumor-node-metastasis (TNM) classification for colorectal cancer (CRC) has limited ability to predict prognosis. Methods We included 45 379 eligible stage I-III CRC patients from the Surveillance, Epidemiology, and End Results Program. Patients were randomly assigned individually to a training (n = 31 772) or an internal validation cohort (n = 13 607). External validation was performed in 10 902 additional patients. Patients were divided according to T and N stage permutations. Survival analyses were conducted by a Cox proportional hazard model and Kaplan-Meier analysis, with T1N0 as the reference. Area under receiver operating characteristic curve and Akaike information criteria were applied for prognostic discrimination and model fitting, respectively. Clinical benefits were further assessed by decision curve analyses. Results We created a modified TNM (mTNM) classification: stages I (T1-2N0-1a); IIA (T1N1b, T2N1b, T3N0); IIB (T1-2N2a-2b, T3N1a-1b, T4aN0); IIC (T3N2a, T4aN1a-2a, T4bN0); IIIA (T3N2b, T4bN1a); IIIB (T4aN2b, T4bN1b); and IIIC (T4bN2a-2b). In the internal validation cohort, compared with the AJCC 8th TNM classification, the mTNM classification showed superior prognostic discrimination (area under receiver operating characteristic curve = 0.675 vs 0.667, respectively; 2-sided P < .001) and better model fitting (Akaike information criteria = 70 937 vs 71 238, respectively). Similar findings were obtained in the external validation cohort. Decision curve analyses revealed that the mTNM had superior net benefits over the AJCC 8th TNM classification in the internal and external validation cohorts. Conclusions The mTNM classification provides better prognostic discrimination than AJCC 8th TNM classification, with good applicability in various populations and settings, to help better stratify stage I-III CRC patients into prognostic groups.

Funder

US National Institutes of Health

National Natural Science Foundation of China

China Scholarship Council

Overseas Research Fellowship

Japan Society for the Promotion of Science

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

Reference38 articles.

1. Cancer statistics in China, 2015;Chen;CA Cancer J Clin,2016

2. Colorectal cancer statistics, 2017;Siegel;CA Cancer J Clin,2017

3. Cancer statistics, 2019;Siegel;CA Cancer J Clin,2019

4. AJCC Cancer Staging Manual

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3