Concordance between clinical and pathologic assessment of T and N stages of rectal adenocarcinoma patients who underwent surgery without neoadjuvant therapy: A National Cancer Database analysis
Clinical assessment of T and N stages in rectal cancer is important to guide decision-making. The present study aimed to assess the accuracy of the clinical T and N staging of rectal cancer compared to the pathological staging and their overall agreement in a large cohort of patients. This retrospec...
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| Veröffentlicht in: | European journal of surgical oncology 2023-02, Vol.49 (2), p.426-432 |
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| container_title | European journal of surgical oncology |
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| creator | Emile, Sameh Hany Silva-Alvarenga, Emanuela Horesh, Nir Freund, Michael R. Garoufalia, Zoe Wexner, Steven D. |
| description | Clinical assessment of T and N stages in rectal cancer is important to guide decision-making. The present study aimed to assess the accuracy of the clinical T and N staging of rectal cancer compared to the pathological staging and their overall agreement in a large cohort of patients.
This retrospective study used data from the National Cancer Database (NCDB) between 2004 and 2017. Patients with non-metastatic rectal adenocarcinoma who did not receive neoadjuvant therapy were reviewed and the clinical T and N stages were compared to their pathologic counterparts. The overall concordance between clinical and pathologic assessments was calculated using Kappa coefficient.
The study included 8929 patients (57.3% male) with a mean age of 64 years. Clinical T stage and N stage were identical to pathologic stages in 70.3% and 77.6% of patients, respectively. Sensitivity and specificity of the clinical assessment of N stage was 35.2% and 95.5%, respectively. Concordance between the clinical and pathologic stages was moderate for the T stage (kappa = 0.575) and fair for the N stage (kappa = 0.346). Pathologic T4 stage (OR: 2.12, p |
| doi_str_mv | 10.1016/j.ejso.2022.09.014 |
| format | Article |
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This retrospective study used data from the National Cancer Database (NCDB) between 2004 and 2017. Patients with non-metastatic rectal adenocarcinoma who did not receive neoadjuvant therapy were reviewed and the clinical T and N stages were compared to their pathologic counterparts. The overall concordance between clinical and pathologic assessments was calculated using Kappa coefficient.
The study included 8929 patients (57.3% male) with a mean age of 64 years. Clinical T stage and N stage were identical to pathologic stages in 70.3% and 77.6% of patients, respectively. Sensitivity and specificity of the clinical assessment of N stage was 35.2% and 95.5%, respectively. Concordance between the clinical and pathologic stages was moderate for the T stage (kappa = 0.575) and fair for the N stage (kappa = 0.346). Pathologic T4 stage (OR: 2.12, p < 0.0001), poorly differentiated adenocarcinoma (OR: 1.45, p = 0.026), lymphovascular invasion (OR: 4.5, p < 0.001), and longer time from diagnosis to first treatment (OR = 0.996, p = 0.046) were the independent predictors of N stage discrepancy.
There was a moderate agreement between the clinical and pathologic T stages and a fair agreement between the clinical and pathologic N stages. The clinical assessment of the N stage was highly specific yet had low sensitivity.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2022.09.014</identifier><identifier>PMID: 36257901</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adenocarcinoma - pathology ; Clinical ; Female ; Humans ; Male ; Middle Aged ; N stage ; NCDB ; Neoadjuvant Therapy ; Neoplasm Staging ; Pathologic ; Rectal cancer ; Rectal Neoplasms - pathology ; Retrospective Studies ; T stage</subject><ispartof>European journal of surgical oncology, 2023-02, Vol.49 (2), p.426-432</ispartof><rights>2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology</rights><rights>Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c286t-42662928cf28ff1cf29c4d014472084fadeeec8c4ecba8448420b162f3cec4df3</citedby><cites>FETCH-LOGICAL-c286t-42662928cf28ff1cf29c4d014472084fadeeec8c4ecba8448420b162f3cec4df3</cites><orcidid>0000-0002-1766-9777 ; 0000-0002-3733-9628 ; 0000-0002-2459-8567</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ejso.2022.09.014$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36257901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Emile, Sameh Hany</creatorcontrib><creatorcontrib>Silva-Alvarenga, Emanuela</creatorcontrib><creatorcontrib>Horesh, Nir</creatorcontrib><creatorcontrib>Freund, Michael R.</creatorcontrib><creatorcontrib>Garoufalia, Zoe</creatorcontrib><creatorcontrib>Wexner, Steven D.</creatorcontrib><title>Concordance between clinical and pathologic assessment of T and N stages of rectal adenocarcinoma patients who underwent surgery without neoadjuvant therapy: A National Cancer Database analysis</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Clinical assessment of T and N stages in rectal cancer is important to guide decision-making. The present study aimed to assess the accuracy of the clinical T and N staging of rectal cancer compared to the pathological staging and their overall agreement in a large cohort of patients.
This retrospective study used data from the National Cancer Database (NCDB) between 2004 and 2017. Patients with non-metastatic rectal adenocarcinoma who did not receive neoadjuvant therapy were reviewed and the clinical T and N stages were compared to their pathologic counterparts. The overall concordance between clinical and pathologic assessments was calculated using Kappa coefficient.
The study included 8929 patients (57.3% male) with a mean age of 64 years. Clinical T stage and N stage were identical to pathologic stages in 70.3% and 77.6% of patients, respectively. Sensitivity and specificity of the clinical assessment of N stage was 35.2% and 95.5%, respectively. Concordance between the clinical and pathologic stages was moderate for the T stage (kappa = 0.575) and fair for the N stage (kappa = 0.346). Pathologic T4 stage (OR: 2.12, p < 0.0001), poorly differentiated adenocarcinoma (OR: 1.45, p = 0.026), lymphovascular invasion (OR: 4.5, p < 0.001), and longer time from diagnosis to first treatment (OR = 0.996, p = 0.046) were the independent predictors of N stage discrepancy.
There was a moderate agreement between the clinical and pathologic T stages and a fair agreement between the clinical and pathologic N stages. The clinical assessment of the N stage was highly specific yet had low sensitivity.</description><subject>Adenocarcinoma - pathology</subject><subject>Clinical</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>N stage</subject><subject>NCDB</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Pathologic</subject><subject>Rectal cancer</subject><subject>Rectal Neoplasms - pathology</subject><subject>Retrospective Studies</subject><subject>T stage</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2O0zAUhS0EYsrAC7BAXrJJsB03cRCbUfmVRsNmWFuOc9M6Suzi60zVx-PNcOjAkpUl33M-H99DyGvOSs54_W4sYcRQCiZEydqScfmEbPi2EoXg2-Yp2bBGqqJpVXVFXiCOjLG2atrn5KqqxbZpGd-QX7vgbYi98RZoB-kE4KmdnHfWTNT4nh5NOoQp7J2lBhEQZ_CJhoHe_xnfUUxmD7jeRLBpdfXggzXROh9mswJctiA9HQJdfA_xtBJwiXuIZ3pymb8k6iGYflweTJ6lA0RzPL-nN_Quu4PP1N0aMdKPJpnOIOTHzXRGhy_Js8FMCK8ez2vy4_On-93X4vb7l2-7m9vCClWnQoq6Fq1QdhBqGHg-Wiv7vDPZCKbkkEMDWGUl2M4oKZUUrOO1GCoLWThU1-TthXuM4ecCmPTs0MI0mZx8QS0aUctMqposFRepjQExwqCP0c0mnjVneq1Oj3qtTq_VadbqHCOb3jzyl26G_p_lb1dZ8OEigPzLBwdRo82LtdC7dfG6D-5__N8M6bAq</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>Emile, Sameh Hany</creator><creator>Silva-Alvarenga, Emanuela</creator><creator>Horesh, Nir</creator><creator>Freund, Michael R.</creator><creator>Garoufalia, Zoe</creator><creator>Wexner, Steven D.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1766-9777</orcidid><orcidid>https://orcid.org/0000-0002-3733-9628</orcidid><orcidid>https://orcid.org/0000-0002-2459-8567</orcidid></search><sort><creationdate>202302</creationdate><title>Concordance between clinical and pathologic assessment of T and N stages of rectal adenocarcinoma patients who underwent surgery without neoadjuvant therapy: A National Cancer Database analysis</title><author>Emile, Sameh Hany ; Silva-Alvarenga, Emanuela ; Horesh, Nir ; Freund, Michael R. ; Garoufalia, Zoe ; Wexner, Steven D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c286t-42662928cf28ff1cf29c4d014472084fadeeec8c4ecba8448420b162f3cec4df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Clinical</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>N stage</topic><topic>NCDB</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Pathologic</topic><topic>Rectal cancer</topic><topic>Rectal Neoplasms - pathology</topic><topic>Retrospective Studies</topic><topic>T stage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Emile, Sameh Hany</creatorcontrib><creatorcontrib>Silva-Alvarenga, Emanuela</creatorcontrib><creatorcontrib>Horesh, Nir</creatorcontrib><creatorcontrib>Freund, Michael R.</creatorcontrib><creatorcontrib>Garoufalia, Zoe</creatorcontrib><creatorcontrib>Wexner, Steven D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Emile, Sameh Hany</au><au>Silva-Alvarenga, Emanuela</au><au>Horesh, Nir</au><au>Freund, Michael R.</au><au>Garoufalia, Zoe</au><au>Wexner, Steven D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Concordance between clinical and pathologic assessment of T and N stages of rectal adenocarcinoma patients who underwent surgery without neoadjuvant therapy: A National Cancer Database analysis</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2023-02</date><risdate>2023</risdate><volume>49</volume><issue>2</issue><spage>426</spage><epage>432</epage><pages>426-432</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Clinical assessment of T and N stages in rectal cancer is important to guide decision-making. The present study aimed to assess the accuracy of the clinical T and N staging of rectal cancer compared to the pathological staging and their overall agreement in a large cohort of patients.
This retrospective study used data from the National Cancer Database (NCDB) between 2004 and 2017. Patients with non-metastatic rectal adenocarcinoma who did not receive neoadjuvant therapy were reviewed and the clinical T and N stages were compared to their pathologic counterparts. The overall concordance between clinical and pathologic assessments was calculated using Kappa coefficient.
The study included 8929 patients (57.3% male) with a mean age of 64 years. Clinical T stage and N stage were identical to pathologic stages in 70.3% and 77.6% of patients, respectively. Sensitivity and specificity of the clinical assessment of N stage was 35.2% and 95.5%, respectively. Concordance between the clinical and pathologic stages was moderate for the T stage (kappa = 0.575) and fair for the N stage (kappa = 0.346). Pathologic T4 stage (OR: 2.12, p < 0.0001), poorly differentiated adenocarcinoma (OR: 1.45, p = 0.026), lymphovascular invasion (OR: 4.5, p < 0.001), and longer time from diagnosis to first treatment (OR = 0.996, p = 0.046) were the independent predictors of N stage discrepancy.
There was a moderate agreement between the clinical and pathologic T stages and a fair agreement between the clinical and pathologic N stages. The clinical assessment of the N stage was highly specific yet had low sensitivity.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>36257901</pmid><doi>10.1016/j.ejso.2022.09.014</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1766-9777</orcidid><orcidid>https://orcid.org/0000-0002-3733-9628</orcidid><orcidid>https://orcid.org/0000-0002-2459-8567</orcidid></addata></record> |
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| subjects | Adenocarcinoma - pathology Clinical Female Humans Male Middle Aged N stage NCDB Neoadjuvant Therapy Neoplasm Staging Pathologic Rectal cancer Rectal Neoplasms - pathology Retrospective Studies T stage |
| title | Concordance between clinical and pathologic assessment of T and N stages of rectal adenocarcinoma patients who underwent surgery without neoadjuvant therapy: A National Cancer Database analysis |
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