AJCC Cancer Staging Manual 7th Edition Criteria for Colon Cancer: Do the Complex Modifications Improve Prognostic Assessment?

Abstract

Background The seventh edition of the American Joint Committee on Cancer staging system (AJCC-7) includes significant changes for colon cancer (CC), which are particularly complex in patients with stage II and III disease. We used a national cancer database to determine if these changes improved prediction of survival. Study Design The database of the Surveillance, Epidemiology, and End Results (SEER) Program was queried to identify patients with pathologically confirmed stage I-III CC diagnosed between 1988 and 2008. CC was staged by sixth edition AJCC criteria (AJCC-6) and then restaged by AJCC-7. Five-year disease-specific survival (DSS) and overall survival (OS) were compared. Results After all exclusion criteria were applied, AJCC-6 and AJCC-7 staging was possible in 157,588 patients (68.9%). Bowker's test of symmetry showed that the number of patients per substage was different for AJCC-6 and AJCC-7 (p < 0.001). The Akaike information criteria comparison showed superior fit with the AJCC-7 model (p < 0.001). However, although AJCC-7 staging yielded a progressive decrease in DSS and OS of patients with stage IIA (86.3% and 72.4%, respectively), IIB (79.4% and 63.2%, respectively), and IIC (64.9% and 54.6%, respectively) disease, DSS and OS of patients with stage IIIA disease increased (89% and 79%, respectively). Subset analysis of patients with > 12 lymph nodes examined did not affect this observation. Conclusion AJCC-7 staging of CC does not address all survival discrepancies, regardless of the number of lymph nodes examined. Consideration of other prognostic factors is critical for decisions regarding therapy, particularly for patients with stage II CC.

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