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©The Author(s) 2018.
World J Clin Oncol. Nov 10, 2018; 9(7): 148-161
Published online Nov 10, 2018. doi: 10.5306/wjco.v9.i7.148
Published online Nov 10, 2018. doi: 10.5306/wjco.v9.i7.148
Table 1 Comparison of the tumor-node-metastasis stages between the 7th edition and the 8th edition
7th edition | 8th edition |
Tx: Primary tumor cannot be assessed | Tx: Primary tumor cannot be assessed |
T0: No evidence of primary tumor | T0: No evidence of primary tumor |
Tis: Carcinoma in situ, limited to intraepithelial or invasive lamina propria | Tis: Carcinoma in situ, limited to intraepithelial or invasive lamina propria |
T1: Tumor invading submucosa | T1: Tumor invading submucosa |
T2: Tumor invading the muscularis propria | T2: Tumor invading the muscularis propria |
T3: Tumor penetrating the muscularis propria and arriving at colorectal fat tissue | T3: Tumor penetrating the muscularis propria and arriving at colorectal fat tissue |
T4: Tumor directly invading other organs or structures | T4: Tumor directly invading other organs or structures |
T4a: Tumor penetrating visceral peritoneum | T4a: Tumor penetrating visceral peritoneum |
T4b: Tumor directly invading or adhering to other organs or structures | T4b: Tumor directly invading or adhering to other organs or structures |
Nx: Regional lymph nodes cannot be assessed | Nx: Regional lymph nodes cannot be assessed |
N0: No lymph node metastasis and no tumor deposits (TD) | N0: No lymph node metastasis and no TD |
N1: 1-3 lymph nodes metastases | N1: 1-3 lymph nodes metastases |
N1a: 1 lymph node metastases | N1a: 1 lymph node metastases |
N1b: 2-3 lymph nodes metastases | N1b: 2-3 lymph nodes metastases |
N1c: Although there was no regional lymph node metastasis, TDs were submucosal, mesangial, or peritoneum-covered para-colorectal tissue. | N1c: Although there was no regional lymph node metastasis, TDs were submucosal, mesangial or peritoneum-covered para-colorectal tissue. |
N2: More than or equal to 4 lymph node metastases | N2: More than or equal to 4 lymph node metastases |
N2a: 4-6 regional lymph node metastases | N2a: 4-6 regional lymph node metastases |
N2b: More than or equal to 7 lymph node metastases | N2b: More than or equal to 7 lymph node metastases |
M1: There is distant lymph node metastasis | M1: There is distant lymph node metastasis |
M1a: Metastasis is limited to one organ or site (e.g., liver, lung, ovary, and extra-regional lymph node metastases) | M1a: Metastasis is limited to one organ or site (e.g., liver, lung, ovary, and extra-regional lymph node metastases) |
M1b: Transfer more than one organ or site, or to the peritoneum1 | M1b: Transfer more than one organ or site1 |
M1c: Peritoneal metastases with or without metastasis of other organs1 |
Table 2 Colorectal cancer tumor-node-metastasis staging American Joint Committee on Cancer 7th and 8th editions
7th edition | 8th edition | ||||||
Stage | T | N | M | Stage | T | N | M |
0 | Tis | N0 | M0 | 0 | Tis | N0 | M0 |
I | T1-2 | N0 | M0 | I | T1-2 | N0 | M0 |
IIA | T3 | N0 | M0 | IIA | T3 | N0 | M0 |
IIB | T4a | N0 | M0 | IIB | T4a | N0 | M0 |
IIC | T4b | N0 | M0 | IIC | T4b | N0 | M0 |
IIIA | T1-2 | N1/N1c | M0 | IIIA | T1-2 | N1/N1c | M0 |
T1 | N2a | M0 | T1 | N2a | M0 | ||
IIIB | T3-4a | N1/N1c | M0 | IIIB | T3-4a | N1/N1c | M0 |
T2-3 | N2a | M0 | T2-3 | N2a | M0 | ||
T1-2 | N2b | M0 | T1-2 | N2b | M0 | ||
IIIC | T4a | N2a | M0 | IIIC | T4a | N2a | M0 |
T3-4a | N2b | M0 | T3-4a | N2b | M0 | ||
T4b | N1-2 | M0 | T4b | N1-2 | M0 | ||
IVA | Any T | Any N | M1a | IVA | Any T | Any N | M1a |
IVB | Any T | Any N | M1b | IVB | Any T | Any N | M1b |
IVC | Any T | Any N | M1c |
Table 3 American Joint Committee on Cancer 8th edition updates for the colorectal cancer staging system
Update points | Update details | Level of evidence |
Definition of distant transfer (M) | Introduction of M1c, specifically peritoneal metastasis, is an indicator of poor prognosis | I |
Definition of regional lymph nodes (N) | Further introduce the definition of tumor deposit | II |
Recommended additional indicators for guiding clinical practice | Lymphatic vessel infiltration: Reintroducing the meaning of L and V1 positive to correctly understand lymphatic and vascular invasion | I |
Recommended additional indicators for guiding clinical practice | Microsatellite instability: Further explaining its importance as a prognostic risk and efficacy predictor | I |
Recommended additional indicators for guiding clinical practice | Determine the KRAS, NRAS, and BRAF mutations as very important prognostic risk and efficacy predictors | I, II |
Table 4 Two-way classification table of staging based on tumor-node-metastasis staging from AJCC-7thvs tumor-node-metastasis staging from AJCC-8th for patients with stages 0-IV colorectal cancer from 2006-2012 (n = 1090)
TNM staging from AJCC-7th | Total | |||||||||||
0 | I | IIA | IIB | IIC | IIIA | IIIB | IIIC | IVA | IVB | |||
TNM staging from AJCC-8th | 0 | 16 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16 |
I | 0 | 131 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 131 | |
IIA | 0 | 0 | 138 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 138 | |
IIB | 0 | 0 | 0 | 56 | 0 | 0 | 0 | 0 | 0 | 0 | 56 | |
IIC | 0 | 0 | 0 | 0 | 31 | 0 | 0 | 0 | 0 | 0 | 31 | |
IIIA | 0 | 0 | 0 | 0 | 0 | 136 | 0 | 0 | 0 | 0 | 136 | |
IIIB | 0 | 0 | 0 | 0 | 0 | 0 | 400 | 0 | 0 | 0 | 400 | |
IIIC | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 127 | 0 | 0 | 127 | |
IVA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 24 | 0 | 24 | |
IVB | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 9 | |
IVC | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 22 | 22 | |
16 | 131 | 138 | 56 | 31 | 136 | 400 | 127 | 24 | 31 | 1090 |
Table 5 Demographic and clinical characteristics of patients with stage 0-IV colorectal cancer from 2006-2012 (n, mean ± SD)
N0 | N1 | N2 | F or χ2 | P | |
Gender | 2.895 | 0.235 | |||
Male | 242 | 182 | 126 | ||
Female | 234 | 201 | 105 | ||
Age (yr) | 62.46 ± 14.43 | 62.17 ± 14.43 | 61.98 ± 14.70 | 0.095 | 0.909 |
ASA | 6.011 | 0.198 | |||
1 | 362 | 277 | 158 | ||
2 | 102 | 94 | 68 | ||
3 | 12 | 12 | 5 | ||
Primary site | 4.94 | 0.895 | |||
Ileocecum | 36 | 26 | 11 | ||
Right colon | 43 | 30 | 22 | ||
Transverse colon | 70 | 64 | 40 | ||
Left colon | 88 | 72 | 46 | ||
Sigmoid colon | 53 | 34 | 21 | ||
Rectum | 186 | 157 | 91 | ||
Tumor size (cm) | 3.31 ± 1.17 | 3.76 ± 0.82 | 4.11 ± 0.74 | 56.008 | < 0.001 |
Operation method | 8.233 | 0.411 | |||
RHC | 97 | 67 | 43 | ||
LHC | 186 | 154 | 91 | ||
HO | 9 | 6 | 9 | ||
AR | 145 | 112 | 70 | ||
APR | 39 | 44 | 18 | ||
Operation time (m) | 151.59 ± 36.31 | 156.40 ± 34.94 | 153.17 ± 31.30 | 2.044 | 0.130 |
Resection length (cm) | 27.96 ± 9.92 | 27.26 ± 9.83 | 27.65 ± 9.92 | 0.533 | 0.587 |
Blood loss (mL) | 184.39 ± 94.25 | 185.23 ± 95.26 | 194.30 ± 107.32 | 0.879 | 0.416 |
Tumor invasion | 131.640 | < 0.001 | |||
Tis | 16 | 0 | 0 | ||
T1 | 85 | 17 | 9 | ||
T2 | 92 | 75 | 43 | ||
T3 | 162 | 127 | 132 | ||
T4a | 82 | 108 | 22 | ||
T4b | 39 | 56 | 25 | ||
Differentiation | 188.64 | < 0.001 | |||
Well | 150 | 31 | 13 | ||
Moderate | 276 | 296 | 124 | ||
Poor or undifferentiated | 50 | 56 | 94 | ||
Number of LNs examined | 14.70 ± 1.88 | 14.13 ± 1.78 | 14.26 ± 1.85 | 0.408 | 0.665 |
Number of positive LNs | 0 | 1.85 ± 0.73 | 5.46 ± 1.64 | 3050.47 | < 0.001 |
Complication | 4.088 | 0.130 | |||
No | 436 | 349 | 201 | ||
Yes | 40 | 34 | 30 | ||
Chemotherapy | 295.36 | < 0.001 | |||
Yes | 283 | 383 | 229 | ||
No | 193 | 0 | 2 | ||
TNM staging AJCC-7th | 887.08 | < 0.001 | |||
0 | 16 | 0 | 0 | ||
I | 131 | 0 | 0 | ||
IIA | 138 | 0 | 0 | ||
IIB | 56 | 0 | 0 | ||
IIC | 31 | 0 | 0 | ||
IIIA | 45 | 82 | 9 | ||
IIIB | 49 | 234 | 117 | ||
IIIC | 9 | 47 | 71 | ||
IVA | 1 | 15 | 8 | ||
IVB | 0 | 5 | 26 | ||
TNM staging AJCC-8th | 887.32 | < 0.001 | |||
0 | 16 | 0 | 0 | ||
I | 131 | 0 | 0 | ||
IIA | 138 | 0 | 0 | ||
IIB | 56 | 0 | 0 | ||
IIC | 31 | 0 | 0 | ||
IIIA | 45 | 82 | 9 | ||
IIIB | 49 | 234 | 117 | ||
IIIC | 9 | 47 | 71 | ||
IVA | 1 | 15 | 8 | ||
IVB | 0 | 1 | 8 | ||
IVC | 0 | 4 | 18 |
Table 6 Comparison of 5-year disease-free survival and overall survival rate for stage and sub-stage using American Joint Committee on Cancer-7th edition and American Joint Committee on Cancer-8th edition (%)
0 | I | IIA | IIB | IIC | IIIA | IIIB | IIIC | IVA | IVB | IVC | Log-rank χ2 | P | |||
OS | Sub-stage | AJCC-7 | 100 | 98.5 | 82.6 | 76.8 | 67.7 | 65.4 | 60 | 44.9 | 8.3 | 0 | - | 1423.53 | < 0.01 |
AJCC-8 | 100 | 98.5 | 82.6 | 76.8 | 67.7 | 65.4 | 60 | 44.9 | 8.3 | 0 | 0 | 1608.11 | < 0.01 | ||
II | III | IV | |||||||||||||
Stage | AJCC-7 | 100 | 98.5 | 79.1 | 58.2 | 3.6 | 913.56 | < 0.01 | |||||||
AJCC-8 | 100 | 98.5 | 79.1 | 58.2 | 3.6 | 875.46 | |||||||||
DFS | Sub-stage | AJCC-7 | 100 | 93.1 | 78.3 | 73.2 | 61.3 | 65.4 | 56.3 | 37 | 8.3 | 0 | - | 1418.9 | < 0.01 |
AJCC-8 | 93.1 | 78.3 | 73.2 | 61.3 | 65.4 | 56.3 | 37 | 8.3 | 0 | 0 | 1603.4 | < 0.01 | |||
II | III | IV | |||||||||||||
Stage | AJCC-7 | 100 | 93.1 | 74.7 | 54.4 | 3.6 | 875.46 | < 0.01 | |||||||
AJCC-8 | 93.1 | 74.7 | 54.4 | 3.6 | 875.46 | < 0.01 |
- Citation: Tong GJ, Zhang GY, Liu J, Zheng ZZ, Chen Y, Niu PP, Xu XT. 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. World J Clin Oncol 2018; 9(7): 148-161
- URL: https://www.wjgnet.com/2218-4333/full/v9/i7/148.htm
- DOI: https://dx.doi.org/10.5306/wjco.v9.i7.148