Colon Cancer Survival Rates With the New American Joint Committee on Cancer Sixth Edition Staging
ABSTRACT The recently revised American Joint Committee on Cancer (AJCC) sixth edition cancer staging system increased the stratification within colon cancer stages II and III defined by the AJCC fifth edition system. Using nationally representative Surveillance, Epidemiology, and End Results (SEER) data, we compared survival rates associated with colon cancer stages defined according to both AJCC systems.
Using SEER data (from January 1, 1991, through December 31, 2000), we identified 119,363 patients with colon adenocarcinoma and included all patients in two analyses by stages defined by AJCC fifth and sixth edition systems. Tumors were stratified by SEER's "extent of disease" and "number of positive [lymph] nodes" coding schemes. Kaplan-Meier analyses were used to compare overall and stage-specific 5-year survival. All statistical tests were two-sided.
Overall 5-year survival was 65.2%. According to stages defined by the AJCC fifth edition system, 5-year stage-specific survivals were 93.2% for stage I, 82.5% for stage II, 59.5% for stage III, and 8.1% for stage IV. According to stages defined by the AJCC sixth edition system, 5-year stage-specific survivals were 93.2% for stage I, 84.7% for stage IIa, 72.2% for stage IIb, 83.4% for stage IIIa, 64.1% for stage IIIb, 44.3% for stage IIIc, and 8.1% for stage IV. Under the sixth edition system, 5-year survival was statistically significantly better for patients with stage IIIa colon cancer (83.4%) than for patients with stage IIb disease (72.2%) (P<.001).
The AJCC sixth edition system for colon cancer stratifies survival more distinctly than the fifth edition system by providing more substages. The association of stage IIIa colon cancer with statistically significantly better survival than stage IIb in the new system may reflect current clinical practice, in which stage III patients receive chemotherapy but stage II patients generally do not.
- SourceAvailable from: Bingbo Zhang
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- "Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and second in females, with over 1 million new cancer cases and 0.5 million deaths estimated to have occurred each year . The stage where CRC is detected determines patients outcome, with 5-year survival rates of more than 90% for stage I disease and less than 10% for stage IV . High CRC death rates can be significantly reduced by improved treatment and early detection. "
ABSTRACT: Glucose transporter1 (Glut1) plays important roles in treatment of colorectal cancer (CRC) involving early-stage diagnosis, subtype, TNM stage, and therapeutic schedule. Currently, in situ marking and tracking of the tumor biomarkers via clinical imaging remains great challenges in early stage CRC diagnosis. In this study, we have developed a unique cell-targeted, paramagnetic-fluorescent double-signal molecular nanoprobe for CRC in vivo magnetic resonance imaging (MRI) diagnosis and subsequent biopsy. The unique molecular nanoprobe is composed of a fluorescent quantum dot (QD) core; a coating layer of paramagnetic DTPA-Gd coupled BSA ((Gd)DTPA∙BSA), and a surface targeting moiety of anti-Glut1 polyclonal antibody. The engineered (Gd)DTPA∙BSA@QDs-PcAb is 35 nm in diameter and colloidally stable under both basic and acidic conditions. It exhibits strong fluorescent intensities and high relaxivity (r1 and r2: 16.561 and 27.702s(-1) per mM of Gd(3+)). Distribution and expression of Glut1 of CRC cells are investigated by in vitro cellular confocal fluorescent imaging and MR scanning upon treating with the (Gd)DTPA∙BSA@QDs-PcAb nanoprobes. In vivo MRI shows real-time imaging of CRC tumor on nude mice after intravenously injection of the (Gd)DTPA∙BSA@QDs-PcAb nanoprobes. Ex vivo biopsy is subsequently conducted for expression of Glut1 on tumor tissues. These nanoprobes are found biocompatible in vitro and in vivo. (Gd)DTPA∙BSA@QDs-PcAb targeted nanoprobe is shown to be a promising agent for CRC cancer in vivo MRI diagnosis and ex vivo biopsy analysis. The "imaging-biopsy" is a viable strategy for tumor reconfirmation with improved diagnostic accuracy and biopsy in personalized treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.Biomaterials 04/2015; 48. DOI:10.1016/j.biomaterials.2015.01.011 · 8.31 Impact Factor
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- "Activation of the PI3K / Akt pathway was recently associated with increased cell growth , migration and invasion in colon cancer cell lines , processes underlying enhanced metastasis ( Wang et al , 2013 ) . Although a number of clinical staging systems is available to identify patients with high risk of recurrence ( Astler and Coller , 1954 ; Gunderson et al , 2004 ; O ' Connell et al , 2004 ; Kozak and Moody , 2008 ) , none of the systems suggested so far can identify patients with a high risk of recurrence in the group of stage II cancer patients with sufficient accuracy ( O ' Connell et al , 2004 ; "
ABSTRACT: Background: Patients with UICC/AJCC stage II colon cancer have a high 5-year overall survival rate after surgery. Nevertheless, a significant subgroup of patients develops tumour recurrence. Currently, there are no clinically established biomarkers available to identify this patient group. We applied reverse-phase protein arrays (RPPA) for phosphatidylinositide-3-kinase pathway activation mapping to stratify patients according to their risk of tumour recurrence after surgery. Methods: Full-length proteins were extracted from formalin-fixed, paraffin-embedded tissue samples of 118 patients who underwent curative resection. RPPA technology was used to analyse expression and/or phosphorylation levels of six major factors of the phosphatidylinositide-3-kinase pathway. Oncogenic mutations of KRAS and BRAF, and DNA microsatellite status, currently discussed as prognostic markers, were analysed in parallel. Results: Expression of phospho-AKT (HR=3.52; P=0.032), S6RP (HR=6.3; P=0.044), and phospho-4E-BP1 (HR=4.12; P=0.011) were prognostic factors for disease-free survival. None of the molecular genetic alterations were significantly associated with prognosis. Conclusions: Our data indicate that activation of the PI3K/AKT pathway evidenced on the protein level might be a valuable prognostic marker to stratify patients for their risk of tumour recurrence. Beside adjuvant chemotherapy targeting of upregulated PI3K/AKT signalling may be an attractive strategy for treatment of high-risk patients.British Journal of Cancer 03/2014; 110(8). DOI:10.1038/bjc.2014.100 · 4.82 Impact Factor
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- "CRC contexts contain many disgust elicitors (Reynolds, Consedine, Pizarro, et al., 2013) and while avoidance is understandable in light of disgust's evolved functions, it may be unhelpful, in many, if not most, health decision contexts if avoidance of screenings and treatment are a consequence. Late presentation and/or treatment delay or withdrawal for example, bode ill for prognoses (O'Connell et al., 2004) and these data suggest that disgust may act as an affective substrate for avoidant decision-making in CRC disease. "
ABSTRACT: Objective: To evaluate whether trait and experimentally manipulated state disgust independently and/or interactively predict immediate and anticipated avoidance in decision scenarios related to colorectal cancer (CRC). Method: Eighty participants, aged 18 to 66 years, completed questionnaires assessing trait disgust prior to a laboratory session. Participants were gender block randomized to disgust or control conditions before completing tasks assessing immediate avoidance of a CRC disgust elicitor (stoma bag) and anticipated avoidance in hypothetical CRC scenarios. Results: Manipulation checks confirmed the elicitation of disgust in the experimental condition. Persons in the experimental condition were more likely to exhibit immediate avoidance behaviors in response to a commonly used bowel disease device (stoma bag), and trait disgust predicted time to touch the device. Trait disgust also moderated the influence of state disgust on anticipated avoidance, namely delay in help seeking for bowel symptoms and predicted rating disgusting side effects as more deterring to adherence. Conclusions: The current report suggests the importance of examining disgust in CRC contexts and provides the first empirical demonstration that state and trait aspects of disgust may interactively operate to deter certain types of decisions. It thus furthers understanding of emotions and avoidance in a health context that has had surprisingly little focus to date. (PsycINFO Database Record (c) 2014 APA, all rights reserved).Health Psychology 01/2014; DOI:10.1037/hea0000023 · 3.95 Impact Factor