
==== Front
Ann Surg Oncol
Ann Surg Oncol
Annals of Surgical Oncology
1068-9265
1534-4681
Springer International Publishing Cham

39075245
15956
10.1245/s10434-024-15956-9
ASO Author Reflections
ASO Author Reflections: Clinical Staging of Localized Colon Cancer: Room for Improvement
Emile Sameh Hany MBBCh, MSc, MD, FACS 12
Wexner Steven D. MD, PhD (Hon) wexners@ccf.org

1
1 https://ror.org/0155k7414 grid.418628.1 0000 0004 0481 997X Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL USA
2 https://ror.org/01k8vtd75 grid.10251.37 0000 0001 0342 6662 Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
29 7 2024
29 7 2024
2024
31 10 64766477
17 7 2024
18 7 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
issue-copyright-statement© Society of Surgical Oncology 2024
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pmcPreoperative clinical assessment of colon cancer is imperative to assess the TNM stage of the disease and help guide management. Clinical assessment is undertaken using imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT. CT scanning is perhaps the most widely used modality for clinical assessment. Despite having good diagnostic accuracy in identifying locally advanced T3-T4 colon cancers, the accuracy of a CT scan in the detection of nodal disease is limited, with a sensitivity and specificity of 62% and 70%, respectively.1

The present study2 found that clinical assessment of the T and N stages of colon cancer had only moderate agreement with the final pathologic stages. The agreement was more pronounced for the T stage in left colon cancers. While clinical assessment was highly specific for the T and N stages, it had a lower sensitivity of 64.3–77.2% for T stage and 41.6–54.5% for N stage, lower than what has been previously reported.1 One important observation was that the accuracy of clinical assessment in the detection of advanced TN stages was higher than that for earlier stages, as 90.1% of stage III patients were correctly staged compared with 60.4% of stage I patients. The poor accuracy of clinical assessment of nodal disease may be attributable to patient and tumor characteristics. A recent study3 found patients <65 years of age, patients with left-sided and high-grade cancers and elevated carcinoembryonic antigen (CEA) were more likely to have their nodal status clinically understaged.

The findings of the present study have important implications, as clinical assessment is more accurate in patients with advanced stage and thus neoadjuvant chemotherapy may be indicated in these patients. Conversely, approximately 25% of patients with advanced colon cancer would be clinically understaged, thus patients identified in imaging studies to have early-stage disease may need to be thoroughly assessed with other imaging modalities before surgery.

Disclosures

Steven Wexner has received consulting fees from Baxter, BD, GSK, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, and Virtual Ports; royalties for intellectual property from Intuitive Surgical, Karl Storz Endoscopy America, and Unique Surgical Innovations; has stock options in Intuitive Surgical, Pragma/GibLib, and Renew Medical; and is a member of the Data Safety Monitoring Boards for JSR/WCG/ACI and PolyPid. Sameh Hany Emile has no conflicts of interest to declare that may be relevant to the contents of this work.

This article refers to: Emile SH, Horesh N, Garoufalia Z, et al. Accuracy of Clinical Staging of Localized Colon Cancer; a National Database Cohort Analysis. Annals Surgical Oncology. In press. https://doi.org/10.1245/s10434-024-15875-9

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References

1. Shkurti J Van den Berg K Van Erning FN Lahaye MJ Beets-Tan RG Nederend J Diagnostic accuracy of CT for local staging of colon cancer: a nationwide study in the Netherlands Eur J Cancer. 2023 19 113314 10.1016/j.ejca.2023.113314
Shkurti J, Van den Berg K, Van Erning FN, Lahaye MJ, Beets-Tan RG, Nederend J. Diagnostic accuracy of CT for local staging of colon cancer: a nationwide study in the Netherlands. Eur J Cancer. 2023;19:113314. 10.1016/j.ejca.2023.113314.
2. Emile SH, Horesh N, Garoufalia Z, et al. Accuracy of clinical staging of localized colon cancer; a national database cohort analysis. Ann Surg Oncol. In press. 10.1245/s10434-024-15875-9
3. Dourado J, Rogers P, Emile S, et al. Predictors of nodal positivity in clinically under-staged patients with colon cancer: A National Cancer Database study and proposal of a predictive scoring system. Am J Surg. Epub 24 May 2024. 10.1016/j.amjsurg.2024.115777.
