Comparison of the eighth version of the American Joint Committee on Cancer manual to the seventh version for colorectal cancer: A retrospective review of our data

Abstract

AIMTo analyze the survival trends in colorectal cancer (CRC) based on the different classifications recommended by the seventh and eighth editions of the American Joint Committee on Cancer staging system (AJCC-7th and AJCC-8th).METHODSThe database from our institution was queried to identify patients with pathologically confirmed stage 0-IV CRC diagnosed between 2006 and 2012. Data from 2080 cases were collected and 1090 cases were evaluated through standardized inclusion and exclusion criteria. CRC was staged by AJCC-7th and then restaged by AJCC-8th. Five-year disease-free survival (DFS) and overall survival (OS) were compared. SPSS 21.0 software was used for all data. DFS and OS were compared and analyzed by Kaplan-Meier and Log-rank test.RESULTSLinear regression and automatic linear regression showed lymph node positive functional equations by tumor-node-metastasis staging from AJCC-7th and tumor-node-metastasis staging from AJCC-8th. Neurological invasion, venous infiltration, lymphatic infiltration, and tumor deposition put forward stricter requirements for pathological examination in AJCC-8th compared to AJCC-7th. After re-analyzing our cohort with AJCC-8th, the percentage of stage IVB cases decreased from 2.8% to 0.8%. As a result 2% of the cases were classified under the new IVC staging. DFS and OS was significantly shorter (P = 0.012) in stage IVC patients compared to stage IVB patients.CONCLUSIONThe addition of stage IVC in AJCC-8th has shown that peritoneal metastasis has a worse prognosis than distant organ metastasis in our institution’s CRC cohort. Additional datasets should be analyzed to confirm these findings.

Cutoff of 25% for Ki67 expression is a good classification tool for prognosis in colorectal cancer in the AJCC‑8 stratification

“…Five-year DFS and OS were analyzed by the Kaplan-Meier method and the Breslow test. Survival rates were equally assessed by multivariable Cox's regression according to various clinical, pathological, and biochemical parameters, which were analyzed in our previous studies (21,26). Patient statuses were divided into two: i) Only death was considered an event, and other parameters were censored for OS analysis; ii) death and recurrence were considered events, and other parameters were censored for DFS analysis.…”

“…In order to improve the prognosis of CRC patients, surgeons and pathologists have made unremitting efforts to examine the prognostic values of various tumor markers. The American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system provides a universal modality and guides clinical treatment (18)(19)(20)(21). Based on the original version, AJCC-8 (American Joint Committee on Cancer 8 edition) provides improved guidance for the individualized treatment of CRC patients and more effective treatment of patients with IVC peritoneal metastases.…”

N-Glycomic Signature of Stage II Colorectal Cancer and Its Association With the Tumor Microenvironment

“…CRC patients are stratified using the 8 th edition of the TNM staging system based on the depth of invasion of the primary tumor, nodal involvement and presence of distant metastases [3]. Stage I CRC patients have a 5-year survival rate of 98.5%, which decreases to an average of 75.7% and 56.7% for stage II and III patients [3,4]. According to the Dutch guideline for the treatment of colorectal cancer, stage II patients are not treated with adjuvant chemotherapy.…”

Radiological Staging of Rectal Cancer in a Resource Limited Setting

“…All CT scans were discussed by the radiologists and surgeons at a weekly meeting prior to the release of a nal report. Post-operative specimens were staged according to the American Joint Committee on Cancer Staging (AJCC) 8th TNM model by the Department of Pathology, Faculty of Medicine, University of Colombo (13). Ethics approval was obtained from the Ethical Review Committee of the National Hospital of Sri Lanka.…”