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

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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.


  • Olav Dahl
  • Mette Pernille Myklebust
  • Jon Espen Dale
  • Otilia Leon
  • Eva Serup-Hansen
  • Anders Jakobsen
  • Per Pfeiffer
  • Inger Marie Løes
  • Frank Pfeffer
  • Karen Lise Garm Spindler
  • Marianne Grønlie Guren
  • Bengt Glimelius
  • Anders Johnsson
Externa organisationer
  • Haukeland University Hospital
  • University of Bergen
  • Skåne University Hospital
  • University of Copenhagen
  • University of Southern Denmark
  • Odense University Hospital
  • Aarhus University Hospital
  • Oslo university hospital
  • Uppsala universitet
  • Herlev Hospital
  • Vejle Hospital

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Cancer och onkologi
TidskriftActa Oncologica
StatusE-pub ahead of print - 2020 jun 23
Peer review utfördJa
Externt publiceradJa