Summary
The pTNM staging system for colorectal cancer (CRC) is not entirely effective in discriminating
between potentially curative and non-curative resections because it does not account
for local residual tumour in patients with stages I, II or III. This study aimed to
evaluate the prognostic importance of histologically verified tumour in any line of
resection of the bowel resection specimen (TLR) in relation to pTNM stages and to
demonstrate how TLR may be integrated into pTNM staging. Information on patients in
the period 1995 to 2010 with complete follow-up to the end of 2015 was extracted from
a prospective database of CRC resections. The outcome variables were the competing
risks incidence of CRC recurrence and CRC-specific death. After exclusions, 2220 patients
remained. In 1930 patients with pTNM stages I–III tumour, recurrence was markedly
higher in those with TLR than in those without (HR 6.0, 95% CI 4.2–8.5, p < 0.001) and this persisted after adjustment for covariates associated with recurrence.
CRC-specific death was markedly higher in the presence of TLR (HR 7.7, CI 5.3–11.2,
p < 0.001), which persisted after adjustment for relevant covariates. These results
justify removing patients with TLR from pTNM stages I to III and placing them in stage
IV, thereby allowing the categorisation of all patients with any known residual tumour
into three prognostically distinct groups. This study demonstrates how TLR may be
integrated into pTNM staging, thus improving the definition of the three stages which
are considered potentially curable (I, II and III).
Key words
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Article info
Publication history
Published online: August 24, 2018
Accepted:
July 30,
2018
Received in revised form:
July 14,
2018
Received:
May 17,
2018
Identification
Copyright
© 2018 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.
