beth568 wrote:Does that make sense? Perhaps I'm wrong about the staging thing, and if so someone can correct me.
greens wrote:My questions are:
1) Is over all prognosis based upon path findings? ---No. It's based on clinical stage unless there was a gross error in clinical stage which UPstages you after surgery (like unseen-on-scan liver mets)
2) Certainly a huge number of studies I have read tend to refer to path findings ALONE when correlating with LR, DFS and OS. In one study which I believe is very authorative for stage 2/3 CRC patients research shows http://www.wjso.com/content/8/1/27 that node positive patients at diagnosis before neo-adjuvant treatment but node negative at path fared equally as well as those who were node negative at all times.
This begs the question if you take two patients who are the same pathalogical stage but one was cT3 N2 at diagnosis and the other was cT3 N0, what impact does the cT3 N2 staging have on over all prognosis for a patient staged pT3 N0? --- They have a worse prognosis - that of the cT3 N2 stage, which is the only one relevant at this time.
3) If treatment is based upon c staging rather than p staging then this would tend to suggest that patients with a different p stage could end up being either over treated or undertreated as it would tend to suggest that prognosis is correlated to diagnosis stage? ---"Overtreatment" is a matter of opinion. No one would be undertreated since anything seen surgically or pathologically that was more serious than the initial clinical stage would UPstage the patient since s/he had been misdx'd clinically.
4) Does downstaging say from c T3 N2 to c T3 N0 ie post neo-adjuvant but pre surgery tell us anything substantial, particularly as clinical scans may indicate improvement in or around the tumor yet the "damage" may already have incurred via sell escape from pelvis and so the downstage may be to quote an English phrase "shutting the stable door after the horse has bolted"? ---in my opinion, no - it tells us nothing and just clouds the issue. YMMV.
greens wrote:I am a T3 N2 diagnosed CRC patient in July who has completed 6 week chemo rad and has recently been re-staged as T3 N0 on basis that tumor has shrunk from 5cm to 3cm, the nodes have shrunk albeit there remains intermittent breaches of the muscular propria ( less so than previous).
Although I am very thankful for this and in particular that I appear to no longer have a threatened margin, I do understand it is only a clinical diagnosis and that crunch is the pathology report. Having said that I hope that the nodes have been sterlilised and that the tumor will continue to retrest from the muscular propria in the next 8 weeks befor my LAR.
greens wrote:Can anyone explain what is meant by P21 expression and CD44v6 expression in the context of T3 CRC and adjuvant chemotherapy for T3 N0 patients ? (albeit I may well not be as my path stage may or may not reveal pos nodes)
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