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Improving colon cancer prognosis using Index of Metastasis: A SEER analysis

Abstract 4019. Improving colon cancer prognosis using Index of Metastasis: A SEER analysis. George J. Chang, Chung-Yuan Hu, Miguel A. Rodriguez-Bigas, John M. Skibber The University of Texas, M.D. Anderson Cancer Center Houston, Texas. Disclosure Slide. Background.

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Improving colon cancer prognosis using Index of Metastasis: A SEER analysis

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  1. Abstract 4019 Improving colon cancer prognosis using Index of Metastasis:A SEER analysis George J. Chang, Chung-Yuan Hu, Miguel A. Rodriguez-Bigas, John M. Skibber The University of Texas, M.D. Anderson Cancer Center Houston, Texas

  2. Disclosure Slide

  3. Background Colon cancer affects approximately 107,000 new patients each year and is the second leading cause of cancer death among men and women. Survival and staging in localized colon cancer is related to the number of lymph nodes containing metastasis. Related to the total number of lymph nodes evaluated. Fewer than one-half of cases of resected colon cancer have had an adequate LN evaluation based on a benchmark of 12 or more lymph nodes.

  4. Limitations of AJCC 6th Edition • American Joint Committee on Cancer (AJCC) TNM staging does not account for the cases with only few lymph nodes. • Survival within an AJCC/TNM stage can range widely due to the heterogeneous nature of the sub-stage cohort and variations in surgical and pathologic quality.

  5. Objective To evaluate the predictive value of the Index of Metastasis (IM) for survival among Stage III colon cancer patients and to define the boundaries of this relationship.

  6. Methods—Data Source and Patient Characteristics Surveillance Epidemiology and End Results (SEER 17) Program of the NCI Patients diagnosed 1988 to 2005, histologically confirmed invasive colon cancer. AJCC 6th edition stage III EXCLUSIONS Age <18, >90 years; >1 primary tumor; missing data regarding lymph nodes.

  7. Methods—Statistical Analysis Patients were stratified by the total number of LN (totLN) evaluated and by IM quartile within each T stage category (T1-2, T3, or T4). Stratified Kaplan-Meier analysis was performed to compare cancer specific survival (CSS). Log-rank cut-point analysis was performed to determine degree of sensitivity of AJCC sub-staging and IM staging to the total number of lymph nodes evaluated. Data were analyzed using STATA Intercooled v.10.0 (rel. 2007, College Station, TX).

  8. Results

  9. Distribution of cases by TN stage and IM quartile

  10. Survival by AJCC Stage varies widely within each stage group and is affected by the total number LN examined

  11. Cancer-specific survival by total number LN examined quartile 73.3 56.1 48.7 39.0

  12. T-stage stratified IM accurately predicts survival

  13. CSS among T3 patients by IM quartile AJCC6 IIIB AJCC6 IIIC 5 yr 56% of patients N1 25% of patients N1

  14. Cut point analysis shows AJCC stage is highly sensitive to totLN IIIB IM Q4 for T3 IIIC

  15. Summary of results 5-year CSS for each AJCC stage group was dependent upon the total number of LN examined. Range of 5-year CSS within a single TN stage group varies based on the total number of LN examined. AJCC staging incorrectly predicts prognosis when few LN are evaluated

  16. Summary of results Cut point analysis demonstrated survival prognosis by AJCC stage is very sensitive to the total number of LN examined. IM reliably predicts CSS and is not sensitive to the total number of LN examined.

  17. Conclusions • AJCC 6th ed. staging poorly predicts prognosis in an individual patient due in part to variability in the total number of LN examined at resection. • When stratified by T stage, index of metastasis more accurately predicts survival and except at the highest IM levels, is not influenced by the number of LN examined.

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