Sun ZG, Wu WX, Chen SX, Zhang YJ, Jie JZ. Improved prognostic stratification of the revised ninth edition American Joint Committee on Cancer staging system for colorectal cancer. World J Gastroenterol 2026; 32(17): 117558 [DOI: 10.3748/wjg.v32.i17.117558]
Corresponding Author of This Article
Jian-Zheng Jie, MD, Chief Physician, Department of General Surgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China. jianzhengjie@sohu.com
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Anatomy & Morphology
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Retrospective Study
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May 7, 2026 (publication date) through Apr 24, 2026
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World Journal of Gastroenterology
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1007-9327
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Sun ZG, Wu WX, Chen SX, Zhang YJ, Jie JZ. Improved prognostic stratification of the revised ninth edition American Joint Committee on Cancer staging system for colorectal cancer. World J Gastroenterol 2026; 32(17): 117558 [DOI: 10.3748/wjg.v32.i17.117558]
World J Gastroenterol. May 7, 2026; 32(17): 117558 Published online May 7, 2026. doi: 10.3748/wjg.v32.i17.117558
Improved prognostic stratification of the revised ninth edition American Joint Committee on Cancer staging system for colorectal cancer
Zhi-Gang Sun, Wen-Xiao Wu, Shao-Xuan Chen, Ya-Jun Zhang, Jian-Zheng Jie
Zhi-Gang Sun, Shao-Xuan Chen, Jian-Zheng Jie, Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Wen-Xiao Wu, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100029, China
Ya-Jun Zhang, Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
Co-first authors: Zhi-Gang Sun and Wen-Xiao Wu.
Co-corresponding authors: Ya-Jun Zhang and Jian-Zheng Jie.
Author contributions: Sun ZG, Wu WX, Zhang YJ, Jie JZ designed the research; Jie JZ, Chen SX assisted in data collection; Wu WX performed literature search, manuscript preparation and statistical analysis; Sun ZG carried out manuscript editing and manuscript review; all authors have read and approved the final manuscript.
Supported by the National Key Research and Development Program of China, No. 2024YFE0198300; and National High Level Hospital Clinical Research Funding, No. 2023-NHLHCRF-BQ-32 and No. 2023-NHLHCRF-YYPPLC-ZR-13.
Institutional review board statement: This study was reviewed and approved by the China-Japan Friendship Hospital Review Board, No. 2024-KY-0147.
Informed consent statement: The requirement to obtain informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Corresponding author: Jian-Zheng Jie, MD, Chief Physician, Department of General Surgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China. jianzhengjie@sohu.com
Received: December 12, 2025 Revised: January 12, 2026 Accepted: February 11, 2026 Published online: May 7, 2026 Processing time: 132 Days and 20.5 Hours
Abstract
BACKGROUND
The 9th edition American Joint Committee on Cancer (AJCC) staging system has been proposed by the AJCC Cancer Expert Panel (AJCCCCEP). The prognostic discriminatory validity of the new staging system in actual patient cohorts has not been fully validated.
AIM
To investigate and validate the proposed changes to the pathologic staging for colon cancer (CC) and rectal cancer (RC) by the AJCCCCEP.
METHODS
The study included 1251 eligible patients with stage I-III CC and 1162 patients with RC between July 2015 and July 2021. Clinicopathological features of the patients were obtained. Patients were staged according to 8th edition AJCC staging system and 9th edition AJCC staging system, respectively. Patients’ outcomes were investigated with respect to overall survival (OS) and disease-free survival (DFS) according to the 8th edition and 9th edition, respectively. The Kaplan-Meier curve and log-rank test were conducted to compare outcomes of patients with different stages. Hazard ratio was calculated using the Cox proportional hazard model.
RESULTS
One thousand, two hundred and fifty-one patients with CC and 1162 patients with RC were analyzed, with a median follow-up of 5.45 and 5.30 years for DFS and OS in the CC cohort and 5.36 and 5.35 years in the RC cohort. All patients were re-classified according to the updated staging system proposed by AJCCCCEP. The survival analysis revealed a hierarchical separation across all sub-levels in the CC cohort and the RC cohort in terms of DFS and OS.
CONCLUSION
This study indicates that the 9th edition AJCC staging system has better prognostic validity than the 8th edition AJCC staging system for patients with CC and RC.
Core Tip: This validation study of 2413 stage I-III colon and rectal cancer patients demonstrates that the proposed 9th edition American Joint Committee on Cancer staging system shows clearer hierarchical separation in overall and disease-free survival, offering better prognostic discrimination compared to the 8th edition.
