title: Prediction of prognosis is not improved by the seventh and latest edition of the TNM classification for colorectal cancer in a single-center collective.
abstract: OBJECTIVE
  To compare the prognostic value of the sixth and seventh editions of the TNM classification, and of additional prognostic factors, in colorectal cancer.
  
  
  BACKGROUND
  The seventh TNM edition was released in 2009 with the aim of providing a more precise prediction of prognosis.
  
  
  METHODS
  Clinical and histopathological data of 2229 patients with colorectal cancer who underwent tumor resection between 1990 and 2006 were analyzed and compared by using the sixth and seventh editions of the TNM classification and a statistically calculated model of prognostic factors.
  
  
  RESULTS
  With the sixth edition, 5-year survival was 96% for stage I, 90% for IIA, 86% for IIB, 90% for IIIA, 72% for IIIB, 48% for IIIC, and 13% for IV. With the seventh edition, 5-year survival was 96% for stage I, 90% for IIA, 84% for IIB, 87% for IIC, 89% for IIIA, 72% for IIIB, 36% for IIIC, 15% for IVA, and 10% for IVB. The stage shifted for only 155 (7%) patients: from IIB to IIC (2%), from IIIB to IIIC (1%), and from IIIC to IIIA/B (4%). The performance of the seventh edition [concordance index (c-index) 0.83; 95% confidence interval (CI), 0.82-0.85] revealed no relevant improvement compared with the sixth edition (c-index 0.83; 95% CI, 0.82-0.84), or compared to a model based on independent prognostic factors (c-index 0.84; 95% CI, 0.83-0.86).
  
  
  CONCLUSIONS
  The seventh TNM edition did not provide greater accuracy in predicting colorectal cancer patients' prognosis but resulted in a more complex classification for daily clinical use.
authors: Department of Surgery, Technische Universität München, Munich, Germany.
authors: Ulrich
authors: U
authors: Nitsche
authors: Matthias
authors: M
authors: Maak
authors: Tibor
authors: T
authors: Schuster
authors: Beat
authors: B
authors: Künzli
authors: Rupert
authors: R
authors: Langer
authors: Julia
authors: J
authors: Slotta-Huspenina
authors: Klaus-Peter
authors: KP
authors: Janssen
authors: Helmut
authors: H
authors: Friess
authors: Robert
authors: R
authors: Rosenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000145:classification / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000145:classification*; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult