Two patients have adenocarcinomas of identical histological appearance. One has a 1.5 cm tumor confined to the bowel wall, while the other has a 6 cm tumor with four regional nodal metastases. Both show the same degree of nuclear pleomorphism on microscopy. Which statement about their assessment is most accurate?
- A Both tumors share the same prognosis because grade is identical
- B The second patient has worse expected survival because stage, not grade, is the stronger prognostic determinant in most solid tumors ✓
- C Grade must be reassessed because it changes once nodal spread occurs
- D Tumor size alone dictates prognosis regardless of nodal status
Correct answer: B. The second patient has worse expected survival because stage, not grade, is the stronger prognostic determinant in most solid tumors
Explanation
Grade reflects cytologic and architectural anaplasia and describes how aggressive the tumor looks, whereas stage reflects the extent of anatomic spread. Across most solid malignancies, stage at diagnosis is the single strongest prognostic factor and outweighs grade, so the patient with nodal metastases carries the worse outlook despite identical differentiation. Grade remains a property of the tumor itself and does not change with dissemination, and nodal status modifies prognosis beyond size alone.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.