Standardized pathological reporting improves stratification of risk for colorectal cancer (CRC) patients

Aims: Assess the impact of standardized pathological reporting over a 5-year period.

Methods: Standardized pathological reporting including TNM classification has been practised in this institution for 5 years. We sought to assess its impact, in comparison to Dukes classification, in risk stratification for cancer recurrence

death

Results: 614 patients were treated for CRC, 492 (80%) of whom had curative surgery. Fifty-five patients (9%) had curative surgery post neo-adjuvant chemoradiotherapy for rectal cancer. Median lymph node yield increased from 11 to 15 over the period. In comparison to Dukes staging (A, B, & C), TNM classification stratified patients into 12 groups with increasing risk. Reporting of lymphovascular & neural invasion further stratified patients within groups. Within the Dukes A group, 21% (n=5) of T1 and 9% (n=3) of T2 tumours showed lymphovascular invasion. Within the Dukes B group, 26% (n=33) of T3 (n=127) and 41% (n=12) of T4 tumours (n=37) showed lymphovascular or perineural invasion. Within Dukes C, 12% (n=18) of patients had >3 lymph nodes positive.

Conclusions: Standardized pathological reporting improves risk stratification in colorectal cancer patients, especially in Dukes B patients, and better informs clinicians with regard to the need for adjuvant chemotherapy.