Is TNM Staging the Most Relevant Prognostic Clinical Factor to Consider for Treatment Decisions Before and After Surgery?

Chapter

Abstract

The tumour nodes metastasis (TNM) system is currently the most utilised staging system to predict outcome and guide the management of patients with rectal cancer. Serial changes to the system have been made over recent years with different versions being used around the world leading to confusion. When determining treatment pathways, multidisciplinary teams (MDT) often take into account various tumour, treatment and patient-related prognostic factors in addition to TNM stage. These additional factors may include tumour type, grade, mismatch repair status, depth of extramural spread, circumferential resection margin status, lymphovascular invasion, tumour budding, tumour cell density, post-treatment regression and plane of surgical excision. This raises the question as to whether a more comprehensive prognostic staging system should be considered rather than the current TNM system.

Keywords

TNM Staging Prognostic factors Rectal cancer 

References

  1. 1.
    Betge J, Pollheimer MJ, Lindtner RA, Kornprat P, Schlemmer A, Rehak P, Vieth M, Hoefler G, Langner C (2012) Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer 118:628–638CrossRefPubMedGoogle Scholar
  2. 2.
    Halvorsen TB, Seim E (1988) Degree of differentiation in colorectal adenocarcinomas: a multivariate analysis of the influence on survival. J Clin Pathol 41:532–537CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kang H, O'Connell JB, Maggard MA, Sack J, Ko CY (2005) A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum 48:1161–1168CrossRefPubMedGoogle Scholar
  4. 4.
    Leonard D, Penninckx F, Laenen A, Kartheuser A; PROCARE (2015) Quantitative contribution of prognosticators to oncologic outcome after rectal cancer resection. Dis Colon Rectum 58:566–574Google Scholar
  5. 5.
    Li J, Guo BC, Sun LR, Wang JW, Fu XH, Zhang SZ, Poston G, Ding KF (2014) TNM staging of colorectal cancer should be reconsidered by T stage weighting. World J Gastroenterol 20:5104–5112CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Maughan NJ, Morris E, Forman D, Quirke P (2007) The validity of the Royal College of Pathologists’ colorectal cancer minimum dataset within a population. Br J Cancer 97:1393–1398CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Morris EJ, Maughan NJ, Forman D, Quirke P (2007) Who to treat with adjuvant therapy in Dukes B/stage II colorectal cancer? The need for high quality pathology. Gut 56:1419–1425CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312CrossRefPubMedGoogle Scholar
  9. 9.
    Nagtegaal ID, Tot T, Jayne DG, McShane P, Nihlberg A, Marshall HC, Påhlman L, Brown JM, Guillou PJ, Quirke P (2011) Lymph nodes, tumor deposits, and TNM: are we getting better? J Clin Oncol 29:2487–2492CrossRefPubMedGoogle Scholar
  10. 10.
    Nielsen LB, Wille-Jorgensen P (2014) National and international guidelines for rectal cancer. Color Dis 16:854–865CrossRefGoogle Scholar
  11. 11.
    Ohrling K, Edler D, Hallström M, Ragnhammar P (2010) Mismatch repair protein expression is an independent prognostic factor in sporadic colorectal cancer. Acta Oncol 49:797–804CrossRefPubMedGoogle Scholar
  12. 12.
    Patel UB, Taylor F, Blomqvist L, George C, Evans H, Tekkis P, Quirke P, Sebag-Montefiore D, Moran B, Heald R, Guthrie A, Bees N, Swift I, Pennert K, Brown G (2011) Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 29:3753–3760CrossRefPubMedGoogle Scholar
  13. 13.
    Pine JK, Morris E, Hutchins GG, West NP, Jayne DG, Quirke P, Prasad KR (2015) Systemic neutrophil-to-lymphocyte ratio in colorectal cancer: the relationship to patient survival, tumour biology and local lymphocytic response to tumour. Br J Cancer 113:204–211CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Porter GA, O'Keefe GE, Yakimets WW (1996) Inadvertent perforation of the rectum during abdominoperineal resection. Am J Surg 172:324–327CrossRefPubMedGoogle Scholar
  15. 15.
    Quasar Collaborative Group (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370:2020–2029CrossRefGoogle Scholar
  16. 16.
    Rogers AC, Gibbons D, Hanly AM, Hyland JM, O'Connell PR, Winter DC, Sheahan K (2014) Prognostic significance of tumor budding in rectal cancer biopsies before neoadjuvant therapy. Mod Pathol 27:156–162CrossRefPubMedGoogle Scholar
  17. 17.
    West NP, Dattani M, McShane P, Hutchins G, Grabsch J, Mueller W, Treanor D, Quirke P, Grabsch H (2010) The proportion of tumour cells is an independent predictor for survival in colorectal cancer patients. Br J Cancer 102:1519–1523CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  1. 1.Pathology and Tumour BiologyLeeds Institute of Cancer and Pathology, University of LeedsLeedsUK

Personalised recommendations