A Novel TNM Classification for Colorectal Cancers based on the Metro-ticket Paradigm

Several revisions of the TNM classifications for colorectal cancer (CRC) have acknowledged that the oncological outcomes of stage IIB/IIC CRC are worse than those of stage IIIA. We aimed to develop a novel TNM (nTNM) classification based on the metro-ticket paradigm. We identified eligible CRC patie...

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Bibliographic Details
Published in:Journal of Cancer 2021-01, Vol.12 (11), p.3299-3306
Main Authors: Pei, Jun-Peng, Zhang, Chun-Dong, Fu, Xiang, Ba, Yong, Yue, Shuai, Zhao, Zhe-Ming, Dai, Dong-Qiu
Format: Article
Language:English
Subjects:
Calibration
Chemotherapy
Classification
Colorectal cancer
Gastric cancer
Lymphatic system
Metastasis
Patients
Radiation therapy
Research Paper
Tumors
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Summary:Several revisions of the TNM classifications for colorectal cancer (CRC) have acknowledged that the oncological outcomes of stage IIB/IIC CRC are worse than those of stage IIIA. We aimed to develop a novel TNM (nTNM) classification based on the metro-ticket paradigm. We identified eligible CRC patients from the Surveillance, Epidemiology, and End Results database. The nTNM was developed using distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages, and was compared with the AJCC TNM classification. The areas under the curves (AUCs), calibration curves, and Akaike's information criterion (AIC) were used to evaluate the predictive performances of the two classifications. Clinical benefits were further estimated by decision curve analyses. The validation cohort was applied to validate these findings. A total of 58,192 CRC patients (40,736 training cohort, 17,456 validation cohort) were finally included. In the training cohort, 18,476 patients (45.4%) experienced upstaging and 15,907 patients (39.0%) experienced downstaging in the nTNM classification compared with the TNM classification. Taking the prognosis of stage I as the reference, survival decreased with increasing nTNM stage. The nTNM classification showed better discrimination (AUC, 0.678 vs. 0.667,
ISSN:1837-9664
1837-9664
DOI:10.7150/jca.55097