Recent randomized trials have suggested improved outcomes in patients with locally advanced colon cancer (LACC) treated with neoadjuvant chemotherapy (NAC). Clinical T and/or N stage was used to identify patients with LACC and consequently, candidates for NAC. The objective of this study was to examine the correlation between clinical and pathologic staging in patients with colon cancer (CC) using a national database.

Adult patients with nonmetastatic CC, who underwent surgery, were identified from the National Cancer Data Base between 2006 and 2014. Data on clinical and pathologic staging were obtained. The kappa index was used to determine the correlation between clinical and pathologic staging.

A total of 105,569 patients were identified. The overall correlation rate between clinical and pathologic staging

for T stage was 80% (kappa 0.7, p < 0.001). Correlation rates for T stage were 54% for T1, 76% for T2, 95% for T3, and 94% for T4. T stage was unchanged in 80%, upstaged in 19%, and downstaged in 1%. The overall correlation rate for N stage was 83% (kappa 0.62, p < 0.001). Correlation rates for N stage were 81% for N0, 82% for N1, and 97% for N2. N stage was unchanged in 83%, upstaged in 16%, and downstaged

in 1%.

Our findings suggest that the current modalities used for clinical staging are most accurate in predicting pathologic stage for advanced T and N stages. Therefore, clinical staging can be reliably used to identify patients with LACC and to guide decisions regarding choice of treatment.