For the Sake of Clarity About pT4 Category of Colorectal Cancer/In Reply by ProQuest


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									                                                 Letters to the Editor

                                           serosal surface, which had become or              GIACOMO PUPPA, MD
For the Sake of Clarity                    would later become immediately ad-                PhD Programme in
About pT4 Category of                      herent to adjacent structures because               Experimental Medicine and
                                           of inflammation.6 In other words, the                Oncology
Colorectal Cancer                          involvement of the visceral peritone-             University of Insubria
                                           um may be ‘‘covered’’ by adhesion to              Varese, Italy
To the Editor.—We read with great in-      adjacent structures or organs associ-
terest the latest guidelines for report-                                                     ANGELICA SONZOGNI, MD
                                           ated with florid inflammation and fi-
ing the relevant features resulting                                                          GIUSEPPE PELOSI, MD
                                           brosis in pT4a tumors.                            Division of Pathology and
from colorectal surgical specimen ex-         In this setting, the frequency of
amination.1,2 We noticed, however,                                                             Laboratory Medicine
                                           distant metastasis has been shown to              European Institute of
major differences in comparison with       be higher in cases with perforation of
the previous guidelines,3,4 and there-                                                         Oncology
                                           the visceral peritoneum compared                  Milan, Italy
fore, we would like to point out some      with cases with direct invasion of ad-
observations about the subclassifica-       jacent organs or structures, and the              GIUSEPPE PELOSI, MD
tion of pT4 category in colorectal can-    median survival time after curative               University of Milan School of
cer.                                       surgery is shorter for patients with                Medicine
   In 2000, the T4 category, which is      pT4b tumors than for those with                   Milan, Italy
the highest one for local extent of co-    pT4a tumors.4,7
lorectal tumor and includes both ex-          In the latest protocol for the ex-
tension into an adjacent structure or                                                    1. Washington MK, Berlin J, Branton PA, et al.
                                           amination of specimens from patients       Protocol for the examination of specimens from pa-
organ and tumor involving the vis-         with primary carcinomas of the colon       tients with primary carcinomas of the colon and rec-
ceral peritoneum, was subdivided           and rectum, however, the definitions        tum. Arch Pathol Lab Med. 2008;132:1182–1193.
into T4a and T4b.3 Taking into ac-                                                       2. Washington K, Berlin J, Branton P, et al. Pro-
                                           of pT4a and pT4b are inverted, be-         tocol for the Examination of Specimens from
count the general rule that, in TNM        cause T4a is applied when tumor            Patients with Primary Carcinomas of the Colon
classification, the categories with                                                    and Rectum. College of American Pathologists;
                                           penetrates the visceral peritoneum         2008.
higher numbers and letters describe
                                           and pT4b is applied when the tumor         cancer/cancer protocols/2008/colonrectum08
the most advanced cancers that result                                                 pw.pdf. Accessed September 5, 2008.
                                           directly invades other organs or
in the poorest prognosis, it was rec-                                                    3. Compton C, Fenoglio-Preiser CM, Pettigrew N,
                                           structures.1,2 To the best of our          Fielding LP. American Joint Committee on Cancer
ommended that the T4 category be
                                           knowledge, no warning has thus far         Prognostic Factors Consensus Conference: Colorec-
modified as follows: T4a, tumor in-                                                    tal Working Group. Cancer. 2000;88:1739–1757.
                                           been put forward to point out these
vades adjacent structures or organs;                                                     4. Compton CC, for the Members of the Can-
                                           contradictory presentations for the        cer Committee, College of American Pathologists.
and T4b, tumor involves the visceral
                                           TNM pT4 category.                          Colon and Rectum. College of American Pathol-
peritoneum.3,4                                                                        ogists.
                                              The identification of patients with
   This statement reflected the fact                                                   protocols/2005/colonrectum05 ckw.pdf. Updated
                                           a high risk for local recurrence and/      January 2005. Accessed September 30, 2005.
that several studies demonstrated the
                                           or distant metastases, who can ben-           5. Shepherd NA, Baxter KJ, Love SB. The prog-
adverse effect on outcome of serosal                                                  nostic importance of peritoneal involvement in co-
                                           efit from further treatment, especially
invasion by tumor.3 I
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