Send to

Choose Destination
See comment in PubMed Commons below
Clin Gastroenterol Hepatol. 2007 Aug;5(8):997-1003. Epub 2007 Jun 4.

Improvement of staging by combining tumor and treatment parameters: the value for prognostication in rectal cancer.

Author information

Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.



Staging of cancer is based on the TNM system. This valuable system takes only tumor-related parameters into account, but in the era of refined surgery and preoperative therapy treatment-related factors are of equal importance. By using rectal cancer as a model we explored the hypothesis that a combination of tumor- and treatment-related parameters will result in improved prognostication.


Standardized clinicopathologic and histologic factors considered predictive for survival were studied in eligible patients treated in a trial for rectal cancer (n = 1324). These factors were analyzed in relation to survival using log-rank tests, Kaplan-Meier curves, and Cox regression both individually and in combination, the latter including TNM staging. A second data set from an independent trial (n = 316) was used for data validation.


Multivariate analysis identified nodal status (P = .001) and circumferential margin (P = .001) involvement as the most important prognostic factors for survival. The combination of these factors formed an improved staging system (node status and circumferential margin [NCRM]) compared with the present TNM staging with respect to 5-year cancer-specific survival. The results were confirmed in our independent patient population.


NCRM staging of rectal cancer results in a broad range of survival rates and favorable patient grouping. Our data give strong evidence that a staging system combing tumor- and treatment-related factors provides better prognostic information than the classic TNM system, which is based solely on tumor-related factors. Similar results might be obtained in other types of cancer in which quality of treatment is important for outcome.

[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center