Evaluation of the stage classification of anal cancer by the TNM 8th version versus the TNM 7th version

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  • Olav Dahl, Haukeland Hosp, University of Bergen, Haukeland University Hospital, Dept Radiol
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  • Mette Pernille Myklebust, Haukeland Hosp, University of Bergen, Haukeland University Hospital, Dept Radiol
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  • Jon Espen Dale, Haukeland Hosp, University of Bergen, Haukeland University Hospital, Dept Radiol
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  • Otilia Leon, Skåne University Hospital, Lund
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  • Eva Serup-Hansen, Københavns Universitet
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  • Anders Jakobsen, a Danish Colorectal Cancer Center South, Vejle Hospital , Vejle , Denmark.
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  • Per Pfeiffer, Syddansk Universitet
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  • Inger Marie Løes, Haukeland Hosp, University of Bergen, Haukeland University Hospital, Dept Radiol
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  • Frank Pfeffer, Haukeland Hosp, University of Bergen, Haukeland University Hospital, Dept Radiol
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  • Karen-Lise Garm Spindler
  • Marianne Grønlie Guren, University of Oslo
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  • Bengt Glimelius, Uppsala University and Uppsala Clinical Research Center, Uppsala University, Sweden.
  • ,
  • Anders Johnsson, Skåne University Hospital, Lund

Background: The UICC TNM 7th edition introduced stage groups for anal cancer which in 2019 has not yet come into general use. The new TNM 8th edition from 2016 defines 7 sub-stages. Background data for these changes are lacking. We aimed to investigate whether the new classification for anal cancer reliably predict the prognosis in the different stages.Patients and methods: The Nordic Anal Cancer Group (NOAC) conducted a large retrospective study of all anal cancers in Norway, Sweden and most of Denmark in 2000-2007. From the Nordic cohort 1151 anal cancer patients with follow-up data were classified by the TNM 4th edition which has identical T, N and M definitions as the TNM 7th edition, and therefore also can be classified by the TNM 7th stage groups. We used the Nordic cohort to translate the T, N and M stages into the TNM 8th stages and sub-stages. Overall survival for each stage was assessed.Results: Although the summary stage groups for TNM 8th edition discriminates patients with different prognosis reasonably well, the analyses of the seven sub-stages show overlapping overall survival: HR for stage IIA 1.30 (95%CI 0.80-2.12) is not significantly different from stage I (p = .30) and HR for stage IIB 2.35 (95%CI 1.40-3.95) and IIIA 2.48 (95%CI 1.43-4.31) are also similar as were HRs for stage IIIB 3.41 (95%CI 1.99-5.85) and IIIC 3.22 (95%CI 1.99-5.20). Similar overlapping was shown for local recurrence and distant spread.Conclusion: The results for the sub-stages calls for a revision of the staging system. We propose a modification of the TNM 8th edition for staging of anal cancer into four stages based on the T, N and M definitions of the TNM 8th classification.

OriginalsprogEngelsk
TidsskriftActa oncologica (Stockholm, Sweden)
Vol/bind59
Nummer9
Sider (fra-til)1016-1023
Antal sider8
ISSN0284-186X
DOI
StatusUdgivet - sep. 2020

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