Prognosis in Dukes' B Colorectal Carcinoma: The Jass Classification Revisited

Objective: To assess whether Jass staging enhances prognostic prediction in Dukes' B colorectal carcinoma. Design: A historical cohort observational study. Setting. A university tertiary care centre, Switzerland. Subjects: 108 consecutive patients. Interventions: Curative resection of Dukes' B colorectal carcinoma between January 1985 and December 1988, Patients with familial adenomatous polyposis; hereditary non-polyposis colorectal cancer; Crohns' disease; ulcerative colitis and synchronous and recurrent tumours were excluded. A comparable group of 155 consecutive patients with Dukes' C carcinoma were included for reference purposes. Main outcome measures: Disease free and overall survival for Dukes' B and overall survival for Dukes' C tumours, Results: Dukes' B tumours in Jass group III or with an infiltrated margin had a significantly worse disease-free survival (p = 0.001 and 0.0001, respectively) and those with infiltrated margins had a significantly worse overall survival (p = 0.002). Overall survival among those with Dukes' B Jass III and Dukes' B with infiltrated margins was no better than overall survival among: all patients with Dukes' C tumours. Conclusion: Jass staging and the nature of the margin of invasion allow patients undergoing curative surgery for Dukes' B colorectal carcinoma to be separated into prognostic groups. A group of patients with Dukes' B tumours whose prognosis is inseparable from those with Dukes' C tumours can be identified, the nature of the margin of invasion being used to classify a larger number of patients.