American Joint Committee on Cancer prognostic factors consensus conference

Colorectal working group

Carolyn Compton, Cecilia M. Fenoglio-Preiser, Norman Pettigrew, L. Peter Fielding

Research output: Contribution to journalArticle

450 Citations (Scopus)

Abstract

BACKGROUND. The American Joint Committee on Cancer (AJCC), which regularly reviews TNM staging systems, established a working party to develop recommendations for colorectal carcinoma. METHODS. A multidisciplinary consensus conference using published literature developed an arbitrary classification system of prognostic marker value (Category I, IIA, IIB, III, and IV) which forms the framework for this report. RESULTS. The working parry concluded that several T categories should be subdivided: pTis into intraepithelial carcinoma (pTie) and intramucosal carcinoma (pTim); pT1 into pT1a and pT1b corresponding to the absence or presence of blood or lymphatic vessel invasion, respectively; and pT4 into pT4a and pT4b according to the absence or presence of tumor involving the surface of the specimen, respectively. The working party also recommended that TNM groups be stratified based on the presence or absence of elevated serum levels of carcinoembryonic antigen (CEA) (≥ 5 ng/mL) on preoperative clinical examination. In addition, the working party also concluded that carcinoma of the appendix should be excluded from the colorectal carcinoma staging system because of fundamental differences in natural history. CONCLUSIONS. The TNM categories and stage groupings for colorectal carcinoma published in the current AJCC manual have clinical and academic value. However, a few categories require subdivision to provide increasing discrimination for individual patients. The serum marker CEA should be added to the staging system, whereas multiple other factors should be recorded as part of good clinical practice. Although many molecular and oncogenic markers show promise to supplement or modify the current staging systems eventually, to the authors' knowledge none have yet been evaluated sufficiently to recommend their inclusion in the TNM system. (C) 2000 American Cancer Society.

Original languageEnglish (US)
Pages (from-to)1739-1757
Number of pages19
JournalCancer
Volume88
Issue number7
DOIs
StatePublished - Apr 1 2000
Externally publishedYes

Fingerprint

Colorectal Neoplasms
Carcinoembryonic Antigen
Carcinoma
Neoplasms
Lymphatic Vessels
Neoplasm Staging
Differentiation Antigens
Carcinoma in Situ
Natural History
Blood Vessels
Biomarkers
Serum

Keywords

  • Colorectal carcinoma
  • Host response
  • Molecular marker
  • Oncogenes
  • Predictive factor
  • Prognostic factor
  • Staging
  • Staging systems
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

American Joint Committee on Cancer prognostic factors consensus conference : Colorectal working group. / Compton, Carolyn; Fenoglio-Preiser, Cecilia M.; Pettigrew, Norman; Fielding, L. Peter.

In: Cancer, Vol. 88, No. 7, 01.04.2000, p. 1739-1757.

Research output: Contribution to journalArticle

Compton, Carolyn ; Fenoglio-Preiser, Cecilia M. ; Pettigrew, Norman ; Fielding, L. Peter. / American Joint Committee on Cancer prognostic factors consensus conference : Colorectal working group. In: Cancer. 2000 ; Vol. 88, No. 7. pp. 1739-1757.
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abstract = "BACKGROUND. The American Joint Committee on Cancer (AJCC), which regularly reviews TNM staging systems, established a working party to develop recommendations for colorectal carcinoma. METHODS. A multidisciplinary consensus conference using published literature developed an arbitrary classification system of prognostic marker value (Category I, IIA, IIB, III, and IV) which forms the framework for this report. RESULTS. The working parry concluded that several T categories should be subdivided: pTis into intraepithelial carcinoma (pTie) and intramucosal carcinoma (pTim); pT1 into pT1a and pT1b corresponding to the absence or presence of blood or lymphatic vessel invasion, respectively; and pT4 into pT4a and pT4b according to the absence or presence of tumor involving the surface of the specimen, respectively. The working party also recommended that TNM groups be stratified based on the presence or absence of elevated serum levels of carcinoembryonic antigen (CEA) (≥ 5 ng/mL) on preoperative clinical examination. In addition, the working party also concluded that carcinoma of the appendix should be excluded from the colorectal carcinoma staging system because of fundamental differences in natural history. CONCLUSIONS. The TNM categories and stage groupings for colorectal carcinoma published in the current AJCC manual have clinical and academic value. However, a few categories require subdivision to provide increasing discrimination for individual patients. The serum marker CEA should be added to the staging system, whereas multiple other factors should be recorded as part of good clinical practice. Although many molecular and oncogenic markers show promise to supplement or modify the current staging systems eventually, to the authors' knowledge none have yet been evaluated sufficiently to recommend their inclusion in the TNM system. (C) 2000 American Cancer Society.",
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