Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification
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ORIGINAL ARTICLE
Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification Michiru Arabiki1 · Yoshifumi Shimada1 · Mae Nakano1 · Kana Tanaka1 · Hidehito Oyanagi1 · Masato Nakano1 · Yiwei Ling2 · Shujiro Okuda2 · Yasumasa Takii3 · Toshifumi Wakai1 Received: 23 February 2020 / Accepted: 3 May 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose The 9th Japanese Classification of Colorectal Cancer (9th JSCCR) has two main differences from the TNM classification (8th AJCC): first, main or lateral lymph node metastasis is classified as jN3; second, tumor nodules (ND) are treated as lymph node metastasis. In this study, we verified the 9th JSCCR for rectal cancer, focusing on the differences with the 8th AJCC. Methods This retrospective analysis involved 212 patients with stage I-III rectal cancer. ND was evaluated using wholemount sections. We evaluated the relapse-free survival of each staging system, and compared the prognostic significance of the different staging systems using the Akaike information criterion (AIC) and Harrell’s concordance index (c-index). Results Main or lateral lymph node metastasis was detected in nine of 212 (4%) patients. ND was detected in 79 of 212 (37%) patients. The best risk stratification power was observed in the 9th JSCCR (AIC, 759; c-index, 0.708) compared with the 7th JSCCR (AIC, 771; c-index, 0.681), 8th JSCCR (AIC, 768; c-index, 0.696), and the 8th AJCC (AIC, 766; c-index, 0.691). Conclusions The 9th JSCCR, which includes the concepts of jN3 and ND, is useful for the risk stratification of rectal cancer, and the contributes to precise decision-making for follow-up management and adjuvant therapy. Keywords Rectal cancer · The Japanese staging system · Whole-mount section · TNM classification · Akaike information criterion
Introduction The ninth edition of the Japanese Classification of Colorectal Cancer defined by the Japanese Society for Cancer of the Colon and Rectum (9th JSCCR) [1] was modified in agreement with the eighth edition of the TNM classification defined by the American Joint Committee on Cancer (8th AJCC) [2]. In the 8th AJCC, regional lymph nodes are classified as N1 (one to three nodes) or N2 (four or more nodes) * Yoshifumi Shimada [email protected]‑u.ac.jp 1
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1‑757 Asahimachi‑dori, Chuo‑ku, Niigata City, Niigata 951‑8510, Japan
2
Division of Bioinformatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
3
Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
according to the number of nodes affected by metastasis. N1 is subdivided into N1a (one node) and N1b (two or three nodes), and N2 is subdivided into N2a (four to six nodes) and N2b (seven or more), because each subgroup represents roughly half the population of N1 and N2 categories, and the subgroups with fewer positive nodes have better survival than those wit
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