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

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

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review


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.

Sidor (från-till)1016-1023
TidskriftActa Oncologica
Tidigt onlinedatum2020 juni 23
StatusPublished - 2020
Externt publiceradJa

Ämnesklassifikation (UKÄ)

  • Cancer och onkologi


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