P-TNM staging system for colon cancer: combination of P-stage and AJCC TNM staging system for improving prognostic prediction and clinical management.
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ABSTRACT: This 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.Eligible 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.A 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).P-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.
SUBMITTER: Liu Q
PROVIDER: S-EPMC6074826 | biostudies-other | 2018
REPOSITORIES: biostudies-other
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