TN Categorization for Rectal and Colon Cancers Based on National Survival Outcome Data
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Transcript of TN Categorization for Rectal and Colon Cancers Based on National Survival Outcome Data
LLG03999
TN Categorization for Rectal and Colon Cancers Based on National Survival Outcome Data
1Mayo Clinic Cancer Center – Arizona; Scottsdale, AZ2National Cancer Institute, Rockville, MD
3Mayo Clinic Cancer Center – Rochester; Rochester, MN4Carolinas Medical Center; Charlotte, NC
5American College of Surgeons; Chicago, IL
1Mayo Clinic Cancer Center – Arizona; Scottsdale, AZ2National Cancer Institute, Rockville, MD
3Mayo Clinic Cancer Center – Rochester; Rochester, MN4Carolinas Medical Center; Charlotte, NC
5American College of Surgeons; Chicago, IL
LL Gunderson1, JM Jessup 2, DJ Sargent
3,FL Greene
4, A Stewart 5
for the AJCC Hindgut Taskforce (HTF)
LL Gunderson1, JM Jessup 2, DJ Sargent
3,FL Greene
4, A Stewart 5
for the AJCC Hindgut Taskforce (HTF)
LLG03999
Colorectal Cancer – TN Categorization Background
AJCC 6th Edition: Added outcomes-based substaging
• Stage II subdivided: IIA (T3N0M0) and IIB (T4N0M0)
• Stage III subdivided: IIIA (T1-2N1), IIIB (T3-4N1), IIIC (TanyN2)
Rectal Pooled Analyses: Outcomes supported revised substaging of Stage III
• T1-2N2 cancers - survival and relapse similar to T4N0 (IIB) or T3N1 (IIIA)
• T4N1 cancers – survival and relapse similar to T3N2 and T4N2
AJCC Hindgut Taskforce - sought validation in a population-based dataset that depth of invasion interacts with nodal status to affect survival
AJCC 6th Edition: Added outcomes-based substaging
• Stage II subdivided: IIA (T3N0M0) and IIB (T4N0M0)
• Stage III subdivided: IIIA (T1-2N1), IIIB (T3-4N1), IIIC (TanyN2)
Rectal Pooled Analyses: Outcomes supported revised substaging of Stage III
• T1-2N2 cancers - survival and relapse similar to T4N0 (IIB) or T3N1 (IIIA)
• T4N1 cancers – survival and relapse similar to T3N2 and T4N2
AJCC Hindgut Taskforce - sought validation in a population-based dataset that depth of invasion interacts with nodal status to affect survival
LLG03999
Colorectal CA – Rectal Pooled AnalysisSurvival and Relapse Rates by Risk for Relapse Category^
LLG03999
Colorectal CA – SEER Population-Based Analysis Methods – Patient Group/Tumor Stratification
SEER Population-based data: Jan 1, 1992 to Dec, 2004
Patient Group: Rectal CA – 35,829 patients, Colon CA – 109,953 patients
Tumor Stratification
– Extent of disease: T4N0 stratified by
• ‘Tumor penetrates the surface of visceral peritoneum’ (T4a) vs.
• ‘Tumor invades or is adherent to adjacent organs or structures’ (T4b)
– Number of positive nodes (+ LN)
• N1a (1 LN+) vs. N1b (2-3 LN+)
• N2a (4-6 LN+) vs. N2b (≥7 LN+)
SEER Population-based data: Jan 1, 1992 to Dec, 2004
Patient Group: Rectal CA – 35,829 patients, Colon CA – 109,953 patients
Tumor Stratification
– Extent of disease: T4N0 stratified by
• ‘Tumor penetrates the surface of visceral peritoneum’ (T4a) vs.
• ‘Tumor invades or is adherent to adjacent organs or structures’ (T4b)
– Number of positive nodes (+ LN)
• N1a (1 LN+) vs. N1b (2-3 LN+)
• N2a (4-6 LN+) vs. N2b (≥7 LN+)
LLG03999
Colon CA – TN Categorization, SEER AnalysisSurvival Results by TN Category, # LN+, # LN Examined
LLG03999
Colon CA – TN Categorization, SEER AnalysisSurvival Results by TN Category, # LN+, # LN Examined
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Rectal CA – TN Categorization, SEER Analysis Survival by Expanded TN Category, TNM Stg I-IIIA
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Rectal CA – TN Categorization, SEER AnalysisSurvival by Expanded TN Category, TNM Stg IIIB-IIIC
LLG03999
Colorectal CA – TN Categorization, SEER AnalysisSurvival by Expanded TN Category, Rectum vs Colon
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Colorectal CA – Survival by TN Category, SEER AnalysesProposed Changes – AJCC Staging, 7th Edition
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Colorectal CA – TN Categorization, SEER Analysis Summary of 5-yr Observed Survival by TN Category
T4a lesions have better prognosis than T4b
• Rectal 5-yr Obs Surv: N0, 55.7 vs. 44.7% ; N1, 48.2 vs. 24.3%
• Colon 5-yr Obs Surv: N0, 60.6 vs. 45.7% ; N1, 47.0 vs. 27.9%
T1-2N2 lesions have better prognosis than T3-4N2
• Rectal 5-yr Obs Surv: 56.1% vs. 37.5% (T3N2) & 26.4% (T4N2)
• Colon 5-yr Obs Surv: 61.5% vs. 38.1% (T3N2) & 21.7% (T4N2)
T4bN1 cancers have prognosis more akin to T4N2 than T4aN1
• Rectal 5-yr Obs Surv: 24.3 vs. 26.4 (T4N2) vs. 48.2% (T4aN1)
• Colon 5-yr Obs Surv: 27.9 vs. 21.7 (T4N2) vs. 47.0% (T4aN1)
Prognosis by nodal status: Related to both number of LN+ andnumber of LN examined
T4a lesions have better prognosis than T4b
• Rectal 5-yr Obs Surv: N0, 55.7 vs. 44.7% ; N1, 48.2 vs. 24.3%
• Colon 5-yr Obs Surv: N0, 60.6 vs. 45.7% ; N1, 47.0 vs. 27.9%
T1-2N2 lesions have better prognosis than T3-4N2
• Rectal 5-yr Obs Surv: 56.1% vs. 37.5% (T3N2) & 26.4% (T4N2)
• Colon 5-yr Obs Surv: 61.5% vs. 38.1% (T3N2) & 21.7% (T4N2)
T4bN1 cancers have prognosis more akin to T4N2 than T4aN1
• Rectal 5-yr Obs Surv: 24.3 vs. 26.4 (T4N2) vs. 48.2% (T4aN1)
• Colon 5-yr Obs Surv: 27.9 vs. 21.7 (T4N2) vs. 47.0% (T4aN1)
Prognosis by nodal status: Related to both number of LN+ andnumber of LN examined
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Colorectal CA – TN Categorization, SEER Analysis Conclusions
SEER population-based analyses validates Rectal Pooled Analysis• Supports shift of T1-2N2 lesions from IIIC to IIIA/IIIB• Supports shift of T4bN1 from IIIB to IIICSEER outcomes support sub-staging of T4, N1 and N2• T4a has better prognosis than T4b for N0, N1, N2 categories• N1a (1 LN+) has better prognosis than N1b (2-3 LN+)• N2a (4-6 LN+) has better prognosis than N2b (> 7 LN+)SEER outcomes support revised substaging of Stg II & III• Subdivide current IIB into IIB(T4aN0) or IIC(T4bN0)• Shift more favorable TN2 categories to earlier stages
IIIA – T1N2aIIIB – T1N2b, T2N2a-b, T3N2a, T4aN2a
Survival Outcomes by TN category
• More similar for rectal and colon cancer than expected • Suggest a complex biological interaction between depth of
invasion and nodal status
SEER population-based analyses validates Rectal Pooled Analysis• Supports shift of T1-2N2 lesions from IIIC to IIIA/IIIB• Supports shift of T4bN1 from IIIB to IIICSEER outcomes support sub-staging of T4, N1 and N2• T4a has better prognosis than T4b for N0, N1, N2 categories• N1a (1 LN+) has better prognosis than N1b (2-3 LN+)• N2a (4-6 LN+) has better prognosis than N2b (> 7 LN+)SEER outcomes support revised substaging of Stg II & III• Subdivide current IIB into IIB(T4aN0) or IIC(T4bN0)• Shift more favorable TN2 categories to earlier stages
IIIA – T1N2aIIIB – T1N2b, T2N2a-b, T3N2a, T4aN2a
Survival Outcomes by TN category
• More similar for rectal and colon cancer than expected • Suggest a complex biological interaction between depth of
invasion and nodal status