TNM staging at colorectal cancer

R. Harisi; Z. Schaff; T. Winternitz; Z. Nemeth; L. Harsanyi; K. Morvay; B. Jaray; P. Kupcsulik; J. Weltner

doi:10.1055/s-2005-869687

Zeitschrift für Gastroenterologie, Table of Contents

TNM staging at colorectal cancer

R Harisi ¹, Z Schaff ², T Winternitz ¹, Z Nemeth ¹, L Harsanyi ¹, K Morvay ¹, B Jaray ², P Kupcsulik ¹, J Weltner ¹

¹1st Department of Surgery, Semmelweis University, Faculty of Medicine, Budapest, Hungary
²1st Department of Pathology, Semmelweis University, Faculty of Medicine, Budapest, Hungary

Abstract

Background: The pre- and intraoperative staging and even more the staging by the pathologist have a significant impact both on the therapy and on the long-term survival. Aim of our study was to compare the results of clinical, surgical and pathological staging.

Materials and methods: 660 patients with colorectal carcinoma were included in the study. The men/women ratio was 349:311, age 61.74 years in average. The distribution of the patients accord-ing to pTNM classification I-II-III-IV was 3.33%, 23.03%, 14.54%, 59.09% consecutively. The rules of classification and staging correspond to the fifth edition of the American Joint Committee on Cancer and to the Union Internationale Contra Cancrum.

Results: Clinical T values were identical with the surgical in 75.15%, with the pathological in 74.54% respectively. The surgical T values were identical with the clinical in 78.48%. At 67.27% of the cases the clinical evaluation of N value was identical with the surgical one. The clinical and pathological evaluation was less effective: the detection ratio of the lymph node metastasis with clinical methods was identical with the pathological result in 60.60% of the cases. The surgical diagnosis of lymph node metastasis matched the pathological finding in 76.66% of the cases. Regarding those cases, when the pathologist was in the position to form an opinion concerning the M value, the coincidence of the diagnoses was as follows: clinical versus pathological 72.72%, surgical versus pathological 90.90%. The coincidence of the clinical and surgical staging was 85.75%. Clinical and surgical TNM stages were by 79.09% in accordance. By decision of the total TNM stage the clinical – pathological staging has shown worse (76.06%), while the surgical-pathological staging has shown a signifi-cantly better (88.48%) matching.

Conclusion: Based on our results we can state, that in one fourth of all colorectal cancer cases the extent of the primary tumor could not have been established correctly. The lymph node involvement was well defined just in more than half of the cases. The M values were accu-rately stated in about three fourth of the cases. To achieve the clinical staging we need better imaging techniques.