Open Access Open Badges Research article

Is the prediction of prognosis not improved by the seventh edition of the TNM classification for colorectal cancer? Analysis of the surveilla006Ece, epidemiology, and end results (SEER) database

Peng Gao, Yong-xi Song, Zhen-ning Wang*, Ying-ying Xu, Lin-lin Tong, Jing-xu Sun, Miao Yu and Hui-mian Xu

Author Affiliations

Department of Surgical Oncology and General Surgery, the First Hospital of China Medical University, Shenyang City, 110001, PR China

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BMC Cancer 2013, 13:123  doi:10.1186/1471-2407-13-123

Published: 17 March 2013



Whether the 7th edition of American Joint Committee on Cancer (AJCC) TNM staging system (AJCC-7) is a successful revision remains debatable. We aimed to compare the predictive capacity of the AJCC-7 for colorectal cancer with the 6th edition of the AJCC TNM staging system (AJCC-6).


The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) dataset consisting of 158,483 records was used in this study. We evaluated the predictive capacity of the two editions of the staging system using Harrell’s C index and Bayesian Information Criterion (BIC).


There was a significant prognostic difference between patients at stage IIB and IIC (P < 0.001). Stage III patients with similar prognoses were adequately sub-grouped in the same stage according to AJCC-7. The Harrell’s C index revealed a value of 0.7692 for AJCC-7, which was significantly better than 0.7663 for AJCC-6 (P < 0.001). BIC analysis provided consistent results (P < 0.001).


This study demonstrates that AJCC-7 is superior to the AJCC-6 staging system in predictive capacity.

TNM system; Colorectal cancer; Prognostic prediction