P–TNM staging system for colon cancer: combination of P-stage and AJCC TNM staging system for improving prognostic prediction and clinical management

Abstract

AimThis study focused on improving the American Joint Committee on Cancer TNM staging system and demonstrated an improvement in prognostic accuracy and clinical management of colon cancer using the P–TNM staging system.Patients and methodsEligible patients (N=56,800) were identified from the Surveillance, Epidemiology, and End Results database between January 1, 2010, and December 31, 2014. The P-stage (P0 or P1) was assigned to each patient based on age at diagnosis, tumor grade, and tumor size. The outcome of interest was cancer-specific survival (CSS). The Cox proportional hazards regression analyses were used to identify independent prognostic factors and analyze the CSS probabilities of patients with colon cancer having different P–TNM stages, respectively.ResultsA total of 29,627 patients were assigned to P0-stage and 27,173 patients were assigned to P1-stage. The P1-stage was associated with a 98.1% increased risk of cancer-specific mortality (hazard ratio =1.981, 95% confidence interval =1.891–2.076, P<0.001), which was higher in patients with nonmetastatic colon cancer. The P1-stage patients had improvement in CSS compared with those in P0-stage in respective stages (P<0.001). Moreover, CSS decreased in stage I–P1 compared with stage IIA–P0 or IIIA–P0 (P<0.001), stage IIIA–P1 compared with stage IIA–P0 (P<0.001), stage IIB–P1 compared with stage IIIB–P0 or IIC–P0 (P<0.001), stage IIIB–P1 compared with stage IIC–P0 (P<0.001), and stage IIC–P1 compared with stage IIIC–P0 (P<0.001).ConclusionP-stage was an independent prognostic factor for colon cancer. This study strongly supported the incorporation of P-stage into the American Joint Committee on Cancer TNM staging system for a better approach to prognostication and, thus, more individualized risk-adaptive therapies in colon cancer.

DNA mismatch repair is not disrupted in stage 0 colorectal cancer resected using endoscopic submucosal dissection

“…From the 66 patients with colorectal neoplasia who underwent endoscopic resection using ESD (63 patients) or EMR (3 patients of adenoma) at the Hamamatsu University Hospital (Hamamatsu, Japan) between April 2015 and March 2020, the DNA MMR tumor status was evaluated using IHC in 41 patients who had been pathologically diagnosed with stage 0 colorectal adenocarcinoma according to pathologic tumor node metastasis staging of colorectal carcinoma (American Joint Committee on Cancer, 8th edition) (25) (Fig. 1).…”

SLC6A14, a Na+/Cl−-coupled amino acid transporter, functions as a tumor promoter in colon and is a target for Wnt signaling

“…This deadly disease starts with the formation of small, benign adenomatous polyps in the colonic epithelial layer that turns into advanced adenoma with high-grade dysplasia; over time, it progresses to an invasive carcinoma (tumor-node-metastasis stages I and II) [3]. If left untreated, invasive colorectal carcinoma transforms into stage III metastatic cancer, which spreads to regional lymph nodes and finally metastasizes to distant organ sites (stage IV) [3][4][5][6]. Molecular events involved in the initiation and progression of colorectal cancer include genetic predisposition, chromosomal instability, and defect in DNA repair mechanisms.…”

Recurrence Rate in a Patient Treated with Colon Resection Followed by Chemotherapy in Comparison to a Patient Treated with Colon Resection without Chemotherapy

“…The American Joint Committee on Cancer (AJCC) categorizes colon cancer patients based on the extent of the primary tumor (T), lymph node involvement (N), and the presence of metastasis (M) [5]. The tumor node metastasis (TNM) staging system is used to stratify colon cancer into five main stages (0 to IV) to facilitate and personalize the treatment of modality and prognosis.…”