Staging of colorectal cancer: Biology vs. morphology

PURPOSE: An accurate determination of the extent or staging of a disease is critical, because it provides the basis for making therapeutic decisions. Staging is a collaborative effort by the surf;eon and the pathologist. Radi oimmunoguided surgery has been evaluated for its ability to help surgeons d etermine: the extent of disease during surgery, when management decisions h ave the most impact on patient care. This study was done to compare radioim munoguided surgery "biostaging" with traditional pathologic staging (TNM) a s predictors of survival in patients undergoing curative resections for col orectal cancer. METHODS: Ninety-seven patients with colorectal cancer were prospectively enrolled in radioimmunoguided surgery protocols. Evaluation o f follow-up survival data was performed. All patients underwent exploratory laparotomy and radioimmuno-guided surgery with resection of their primary colorectal tumor. Survival data were analyzed with the Kaplan-Meier method with log-rank comparisons. RESULTS: Of 97 patients enrolled in the study, 5 9 were evaluable and completely resectable by radioimmunoguided surgery. Me an follow-up was 62 months, with a range of 34 to 89 months. By traditional staging 13 patients were pStage I, 18 patients mere pStage II, and 28 pati ents were pStage III. By radioimmunoguided surgery biostaging, 24 patients were radioimmunoguided surgery-negative whereas 35 patients were radioimmun oguided surgery-positive. Survival rates by pathologic stage approached a s ignificant difference, but did not, as of the conclusion of the study perio d, reach it (P = 0.12). Survival rates based on radioimmunoguided surgery s tatus demonstrated a highly significant difference (P = 0.0002). CONCLUSION S: Radioimmunoguided surgery biostaging provides new information intraopera tively on cancer staging that has not been available before. This may lead to new strategies for therapy that can be individualized and optimized For each patient with cancer.