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A Modified Tumor-Node-Metastasis Classification for Primary Operable Colorectal Cancer
- Source :
- JNCI Cancer Spectrum
- Publication Year :
- 2020
- Publisher :
- Oxford University Press, 2020.
-
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 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.
- Subjects :
- Oncology
Male
Cancer Research
medicine.medical_specialty
Colorectal cancer
Kaplan-Meier Estimate
Article
Decision Support Techniques
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Life Expectancy
Internal medicine
Epidemiology
medicine
Humans
Stage (cooking)
Neoplasm Staging
Proportional Hazards Models
Receiver operating characteristic
business.industry
Proportional hazards model
Cancer
Reproducibility of Results
Middle Aged
medicine.disease
Prognosis
Tumor Burden
ROC Curve
030220 oncology & carcinogenesis
Lymphatic Metastasis
Cohort
030211 gastroenterology & hepatology
Female
Akaike information criterion
business
AcademicSubjects/MED00010
Colorectal Neoplasms
SEER Program
Subjects
Details
- Language :
- English
- ISSN :
- 25155091
- Volume :
- 5
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- JNCI Cancer Spectrum
- Accession number :
- edsair.doi.dedup.....45e5f6958552a726dde1f9913391e87c