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World J Gastroenterol. May 7, 2014; 20(17): 5104-5112
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5104
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5104
TNM staging of colorectal cancer should be reconsidered by T stage weighting
Jun Li, Jian-Wei Wang, Xian-Hua Fu, Su-Zhan Zhang, Ke-Feng Ding, Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, Hangzhou 310009, Zhejiang Province, China
Bao-Cai Guo, Li-Rong Sun, Department of Applied Mathematics, School of Statistics and Mathematics, Zhejiang Gongshang University, Xiasha University Town, Hangzhou 310018, Zhejiang Province, China
Graeme Poston, Department of Surgery, Aintree University Hospital, Liverpool L9 7AL, United Kingdom
Author contributions: Li J and Ding KF raised doubts about the relationship between the 7th edition of the AJCC TNM staging system and the survival of patients with colorectal cancer, and designed the methods, proposed the revised TNM staging system, and wrote the draft of the manuscript; Guo BC and Sun LR undertook the statistical analysis; Wang JW, Fu XH, Zhang SZ and Poston G discussed the hypothesis that the T stage has greater weight in affecting the survival of colorectal cancer patients and took part in the decision-making process for rearranging the TNM staging system and also participated in the study design and revision of the manuscript; all authors have read, revised, and approved the manuscript.
Correspondence to: Ke-Feng Ding, Professor, Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. dingkefeng@zju.edu.cn
Telephone: +86-571-87784760 Fax: +86-571-87783458
Received: October 31, 2013
Revised: February 10, 2014
Accepted: March 4, 2014
Published online: May 7, 2014
Revised: February 10, 2014
Accepted: March 4, 2014
Published online: May 7, 2014
Core Tip
Core tip: The 7th edition of the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system for colorectal cancer can not predict survival linearly by stage. We propose that the T stage has greater weight than the N stage, more especially in rectal cancer than in colon cancer. Moreover, in this article, we propose a revised scheme for the 7th edition of the AJCC TNM staging system. In our revised scheme, T4bN0 is classified to stage IIIa in colon cancer, but to stage IIIb in rectal cancer. This is the first attempt to revise the established TNM staging system for colorectal cancer by shaking the keystone of present classification based on the lymph nodes status.