Cancer Res Treat.  2007 Jun;39(2):61-64.

Differences in Overall Survival When Colorectal Cancer Patients are Stratified into New TNM Staging Strategy

• Oh HS
• Chung HJ
• Kim HK
• Choi JS

Abstract

PURPOSE: The purpose of this study is to determine whether the prognosis can be more precisely gauged by the revised 6th AJCC staging system and if this is suitable for Korean colorectal cancer patients, and especially for those patients in the Youngdong district.
MATERIALS AND METHODS
Between September 1996 and December 2003, 365 patients with histologically confirmed colorectal cancer were analyzed. Kaplan-Meier analyses were used to compare the overall and stage-specific 5-year survival. All the statistical tests were two-sided.
RESULTS
The overall 5-year survival for the entire cohort was 62%. According to the stages defined by the AJCC fifth edition system, the 5-year stage-specific survival was 91% for stage I, 82% for stage II, 51% for stage III and 4% for stage IV. According to the stages defined by the AJCC sixth edition system, the 5-year stage-specific survival was 91% for stage I, 81% forstage IIa, 83% for stage IIb, 100% for stage IIIa, 64% for stage IIIb, 37% for stage IIIc and 4% for stage IV. The 5-year survival was significantly better for the patients with stage IIIb (64%) than those patients with stage IIIc (37%) (p<.001).
CONCLUSION
It is widely known that the AJCC sixth edition system for colorectal cancer stratifies survival more distinctly than does the fifth edition system by providing more substages. Our study showed that stage IIIb disease had better survival than stage IIIc disease, but we couldn't confirm that this new staging system is relevant in our Korean clinical practice due to the small study population. Therefore, further study is required in a larger population.

Keyword

Colorectal neoplasms; Overall survival; Staging

MeSH Terms

Cohort Studies
Colorectal Neoplasms*
Humans
Neoplasm Staging*
Prognosis

Figure

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  Fig. 1 Five-year survival by the American Joint Committee on Cancer fifth edition system (stages I~IV). The p value determined with the log-rank test refers to the corresponding stage and the stage in the row above. All the statistical tests were two-sided.

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  Fig. 2 Five-year survival by the American Joint Committee on Cancer sixth edition system (stages I~IV). The p value determined by the log-rank test refers to the corresponding stage and the stage in the row above, unless otherwise indicated. All the statistical tests were two-sided.

Reference

1. Cancer registry system in Korea. Headquarter of Korea Central Cancer Registry. Available from: http://www.ncc.re.kr.

2. Shin HR, Jung KW, Won YJ, Park JG. 2002 Annual report of the Korea Central Cancer Registry: Based on registered Data from 139 Hospitals. Cancer Res Treat. 2004; 36:103–114.

3. Dukes CE, Bussey HJ. The spread of rectal cancer and its effect on prognosis. Br J Cancer. 1958; 12:309–320. PMID: 13596482.

4. Kirklin JW, Dockerty MD, Waugh JW. The role of the peritoneal reflection in the prognosis of carcinoma of the rectum and sigmoid colon. Surg Gynecol Obstet. 1949; 88:326–331. PMID: 18111779.

5. Astler VB, Coller FA. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg. 1954; 139:846–852. PMID: 13159135.

6. Hutter RV. At last: worldwide agreement on the staging of cancer. Arch Surg. 1987; 122:1235–1239. PMID: 3675187.

7. Missions and objectives. American Joint Committee on Cancer. Last accessed: August 6, 2004. Available from: http://www.cancerstaging.org.

8. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC cancer staging manual. 2002. 6th ed. New York: Springer-Verlag.

9. Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin. 2004; 54:295–308. PMID: 15537574.

10. Greene FL. TNM staging for malignancies of the digestive tract: 2003 changes and beyond. Semin Surg Oncol. 2003; 21:23–29. PMID: 12923913.

11. Jessup JM, Menck HR, Winchester DP, Hundahl SA, Murphy GP. The National Cancer Data Base report on patterns of hospital reporting. Cancer. 1996; 78:1829–1837. PMID: 8859199.

12. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001; 93:583–596. PMID: 11309435.

13. O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004; 96:1420–1425. PMID: 15467030.

14. Lee SC, Lee KH, Kim HS, Lee SH, Choi TH, Park YJ, et al. The comparative study of cancer incidence between urban and rural area in Gangneung: gastric cancer, hepatoma and lung cancer. Korean J Med. 2005; 68:66–75.