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November 1975

A Reappraisal of Staging and Therapy for Patients With Cancer of the Rectum: I. Development of Two New Systems of Staging

Author Affiliations

From the Co-operative Studies Program Support Center and the Department of Medicine of the West Haven Veterans Administration Hospital, West Haven, Conn, and the Departments of Medicine and Epidemiology of the Yale University School of Medicine, New Haven, Conn. Dr. Hull is now with the Louisiana State University Medical Center, New Orleans.

Arch Intern Med. 1975;135(11):1441-1453. doi:10.1001/archinte.1975.00330110031005

• Existing systems of staging for patients with rectal cancer depend almost exclusively on anatomic evidence. Consequently, the stages cannot be determined in advance of therapeutic decisions and cannot be used for patients treated without surgery. Furthermore, the stages contain no provision for important prognostic distinctions that cannot be discerned from anatomic data.

After preparing a taxonomy for hitherto unclassified medical data, we developed and tested two new systems of staging in a cohort of 318 patients. The first system, which can be applied before treatment, is divided into four composite stages that contain elements of symptomatic, chronometric, co-morbid, and para-morbid data, as well as information obtained from physical examination, sigmoidoscopy, and roentgenography. The second system, applicable to patients with resected tumors, is based on a combination of pretherapeutic clinical information and post-surgical anatomic evidence.

The two systems produce prognostic gradients that are clinically distinctive and statistically efficacious.

(Arch Intern Med 135:1441-1453,1975)

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