Predicting survival after curative colectomy for cancer: Individualizing colon cancer staging Journal Article


Authors: Weiser, M. R.; Gonen, M.; Chou, J. F.; Kattan, M. W.; Schrag, D.
Article Title: Predicting survival after curative colectomy for cancer: Individualizing colon cancer staging
Abstract: Purpose: Cancer staging determines extent of disease, facilitating prognostication and treatment decision making. The American Joint Committee on Cancer (AJCC) TNM classification system is the most commonly used staging algorithm for colon cancer, categorizing patients on the basis of only these three variables (tumor, node, and metastasis). The purpose of this study was to extend the seventh edition of the AJCC staging system for colon cancer to incorporate additional information available from tumor registries, thereby improving prognostic accuracy. Methods: Records from 128,853 patients with primary colon cancer reported to the Surveillance, Epidemiology and End Results Program from 1994 to 2005 were used to construct and validate three survival models for patients with primary curative-intent surgery. Independent training/test data sets were used to develop and test alternative models. The seventh edition TNM staging system was compared with models supplementing TNM staging with additional demographic and tumor variables available from the registry by calculating a concordance index, performing calibration, and identifying the area under receiver operating characteristic (ROC) curves. Results: Inclusion of additional registry covariates improved prognostic estimates. The concordance index rose from 0.60 (95% CI, 0.59 to 0.61) for the AJCC model, with T- and N-stage variables, to 0.68 (95% CI, 0.67 to 0.68) for the model including tumor grade, number of collected metastatic lymph nodes, age, and sex. ROC curves for the extended model had higher sensitivity, at all values of specificity, than the TNM system; calibration curves indicated no deviation from the reference line. Conclusion: Prognostic models incorporating readily available data elements outperform the current AJCC system. These models can assist in personalizing treatment and follow-up for patients with colon cancer. © 2011 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; aged; major clinical study; overall survival; cancer staging; lymph node metastasis; cancer diagnosis; neoplasm staging; cancer grading; sensitivity and specificity; tumor differentiation; calibration; colonic neoplasms; cancer mortality; colon cancer; colon resection; predictive value; receiver operating characteristic; personalized medicine; colectomy; individualized medicine
Journal Title: Journal of Clinical Oncology
Volume: 29
Issue: 36
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2011-12-20
Start Page: 4796
End Page: 4802
Language: English
DOI: 10.1200/jco.2011.36.5080
PROVIDER: scopus
PUBMED: 22084366
PMCID: PMC3664036
DOI/URL:
Notes: --- - "Export Date: 1 February 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Joanne Fu-Lou Chou
    153 Chou
  2. Mithat Gonen
    701 Gonen
  3. Deborah Schrag
    137 Schrag
  4. Martin R Weiser
    338 Weiser