Beyond N staging in colorectal cancer: Current approaches and future perspectives
Traditionally, lymph node metastases (LNM) evaluation is essential to the staging of colon cancer patients according to the TNM (tumor–node–metastasis) system. However, in recent years evidence has accumulated regarding the role of emerging pathological features, which could significantly impact the...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.937114/full |
| _version_ | 1828404043755552768 |
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| author | Gianluca Arrichiello Mario Pirozzi Bianca Arianna Facchini Sergio Facchini Fernando Paragliola Valeria Nacca Antonella Nicastro Maria Anna Canciello Adele Orlando Marianna Caterino Davide Ciardiello Carminia Maria Della Corte Morena Fasano Stefania Napolitano Teresa Troiani Fortunato Ciardiello Giulia Martini Erika Martinelli |
| author_facet | Gianluca Arrichiello Mario Pirozzi Bianca Arianna Facchini Sergio Facchini Fernando Paragliola Valeria Nacca Antonella Nicastro Maria Anna Canciello Adele Orlando Marianna Caterino Davide Ciardiello Carminia Maria Della Corte Morena Fasano Stefania Napolitano Teresa Troiani Fortunato Ciardiello Giulia Martini Erika Martinelli |
| author_sort | Gianluca Arrichiello |
| collection | DOAJ |
| description | Traditionally, lymph node metastases (LNM) evaluation is essential to the staging of colon cancer patients according to the TNM (tumor–node–metastasis) system. However, in recent years evidence has accumulated regarding the role of emerging pathological features, which could significantly impact the prognosis of colorectal cancer patients. Lymph Node Ratio (LNR) and Log Odds of Positive Lymph Nodes (LODDS) have been shown to predict patients’ prognosis more accurately than traditional nodal staging and it has been suggested that their implementation in existing classification could help stratify further patients with overlapping TNM stage. Tumor deposits (TD) are currently factored within the N1c category of the TNM classification in the absence of lymph node metastases. However, studies have shown that presence of TDs can affect patients’ survival regardless of LNM. Moreover, evidence suggest that presence of TDs should not be evaluated as dichotomic but rather as a quantitative variable. Extranodal extension (ENE) has been shown to correlate with presence of other adverse prognostic features and to impact survival of colorectal cancer patients. In this review we will describe current staging systems and prognostic/predictive factors in colorectal cancer and elaborate on available evidence supporting the implementation of LNR/LODDS, TDs and ENE evaluation in existing classification to improve prognosis estimation and patient selection for adjuvant treatment. |
| first_indexed | 2024-12-10T10:29:20Z |
| format | Article |
| id | doaj.art-c635368b544c4641a416a5d44b16752a |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-10T10:29:20Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-c635368b544c4641a416a5d44b16752a2022-12-22T01:52:38ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-07-011210.3389/fonc.2022.937114937114Beyond N staging in colorectal cancer: Current approaches and future perspectivesGianluca Arrichiello0Mario Pirozzi1Bianca Arianna Facchini2Sergio Facchini3Fernando Paragliola4Valeria Nacca5Antonella Nicastro6Maria Anna Canciello7Adele Orlando8Marianna Caterino9Davide Ciardiello10Carminia Maria Della Corte11Morena Fasano12Stefania Napolitano13Teresa Troiani14Fortunato Ciardiello15Giulia Martini16Erika Martinelli17Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyOncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, ItalyTraditionally, lymph node metastases (LNM) evaluation is essential to the staging of colon cancer patients according to the TNM (tumor–node–metastasis) system. However, in recent years evidence has accumulated regarding the role of emerging pathological features, which could significantly impact the prognosis of colorectal cancer patients. Lymph Node Ratio (LNR) and Log Odds of Positive Lymph Nodes (LODDS) have been shown to predict patients’ prognosis more accurately than traditional nodal staging and it has been suggested that their implementation in existing classification could help stratify further patients with overlapping TNM stage. Tumor deposits (TD) are currently factored within the N1c category of the TNM classification in the absence of lymph node metastases. However, studies have shown that presence of TDs can affect patients’ survival regardless of LNM. Moreover, evidence suggest that presence of TDs should not be evaluated as dichotomic but rather as a quantitative variable. Extranodal extension (ENE) has been shown to correlate with presence of other adverse prognostic features and to impact survival of colorectal cancer patients. In this review we will describe current staging systems and prognostic/predictive factors in colorectal cancer and elaborate on available evidence supporting the implementation of LNR/LODDS, TDs and ENE evaluation in existing classification to improve prognosis estimation and patient selection for adjuvant treatment.https://www.frontiersin.org/articles/10.3389/fonc.2022.937114/fullcolorectal cancertumor staginglymph node metastasesadjuvant treatmentTNM |
| spellingShingle | Gianluca Arrichiello Mario Pirozzi Bianca Arianna Facchini Sergio Facchini Fernando Paragliola Valeria Nacca Antonella Nicastro Maria Anna Canciello Adele Orlando Marianna Caterino Davide Ciardiello Carminia Maria Della Corte Morena Fasano Stefania Napolitano Teresa Troiani Fortunato Ciardiello Giulia Martini Erika Martinelli Beyond N staging in colorectal cancer: Current approaches and future perspectives Frontiers in Oncology colorectal cancer tumor staging lymph node metastases adjuvant treatment TNM |
| title | Beyond N staging in colorectal cancer: Current approaches and future perspectives |
| title_full | Beyond N staging in colorectal cancer: Current approaches and future perspectives |
| title_fullStr | Beyond N staging in colorectal cancer: Current approaches and future perspectives |
| title_full_unstemmed | Beyond N staging in colorectal cancer: Current approaches and future perspectives |
| title_short | Beyond N staging in colorectal cancer: Current approaches and future perspectives |
| title_sort | beyond n staging in colorectal cancer current approaches and future perspectives |
| topic | colorectal cancer tumor staging lymph node metastases adjuvant treatment TNM |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.937114/full |
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