Breast Cancer—Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Abstract

Answer questions and earn CME/CNEThe revision of the eighth edition of the primary tumor, lymph node, and metastasis (TNM) classification of the American Joint Commission of Cancer (AJCC) for breast cancer was determined by a multidisciplinary team of breast cancer experts. The panel recognized the need to incorporate biologic factors, such as tumor grade, proliferation rate, estrogen and progesterone receptor expression, human epidermal growth factor 2 (HER2) expression, and gene expression prognostic panels into the staging system. AJCC levels of evidence and guidelines for all tumor types were followed as much as possible. The panel felt that, to maintain worldwide value, the tumor staging system should remain based on TNM anatomic factors. However, the recognition of the prognostic influence of grade, hormone receptor expression, and HER2 amplification mandated their inclusion into the staging system. The value of commercially available, gene‐based assays was acknowledged and prognostic input added. Tumor biomarkers and low Oncotype DX recurrence scores can alter prognosis and stage. These updates are expected to provide additional precision and flexibility to the staging system and were based on the extent of published information and analysis of large, as yet unpublished databases. The eighth edition of the AJCC TNM staging system, thus, provides a flexible platform for prognostic classification based on traditional anatomic factors, which can be modified and enhanced using patient biomarkers and multifactorial prognostic panel data. The eighth edition remains the worldwide basis for breast cancer staging and will incorporate future online updates to remain timely and relevant. CA Cancer J Clin 2017;67:290–303. © 2017 American Cancer Society.

Academic dependency

“…Tissue-agnostic drugs are a new class of cancer drugs that are used to treat cancer based on the presence of a molecular biomarker regardless of the tissue affected. Similarly, the upcoming edition of the American Joint Committee on Cancer staging manual, which is the standard cancer staging system worldwide, introduces a two-tier staging system in order to incorporate the use of advanced molecular biomarkers, which are not available in most parts of the world (Giuliano et al 2017). …”

Gene Expression Profiling in Breast Cancer and Its Effect on Therapy Selection in Early-Stage Breast Cancer

“…In the 8th Breast Cancer Staging System of American Joint Committee on Cancer (AJCC), which is to be published in 2018, gene expression profiling is included in breast cancer staging as a prognostic panel (22). 169…”

“…The Oncotype DX staging system has been included in the 8th breast staging system by AJCC (when available as stage modifiers) (22): For patients with HR-positive, HER2-negative and ALN-negative tumors, Oncotype DX recurrence score less than 11, regardless of T size, places the tumor in the same prognostic category as T1a-T1b N0M0, and the tumor is staged using the AJCC prognostic stage group table as stage I (Level of Evidence I).…”

“…It has been included in the 8th breast cancer staging system by the AJCC (when available as stage modifiers) (22): For patients with HRpositive, HER2-negative and ALN-negative tumors, a PAM50 ROR score in the low-range, regardless of T size, places the tumor in the same prognostic category as T1a-T1b N0M0 (Level of Evidence II).…”

“…Breast Cancer Index and EndoPredict (when available as stage modifiers) tests are also included as part of the prognostic panel in the 8th staging booklet (Level of evidence II) (22) (Table 3). …”