The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population‐based to a more “personalized” approach to cancer staging

Abstract

The American Joint Committee on Cancer (AJCC) staging manual has become the benchmark for classifying patients with cancer, defining prognosis, and determining the best treatment approaches. Many view the primary role of the tumor, lymph node, metastasis (TNM) system as that of a standardized classification system for evaluating cancer at a population level in terms of the extent of disease, both at initial presentation and after surgical treatment, and the overall impact of improvements in cancer treatment. The rapid evolution of knowledge in cancer biology and the discovery and validation of biologic factors that predict cancer outcome and response to treatment with better accuracy have led some cancer experts to question the utility of a TNM-based approach in clinical care at an individualized patient level. In the Eighth Edition of the AJCC Cancer Staging Manual, the goal of including relevant, nonanatomic (including molecular) factors has been foremost, although changes are made only when there is strong evidence for inclusion. The editorial board viewed this iteration as a proactive effort to continue to build the important bridge from a "population-based" to a more "personalized" approach to patient classification, one that forms the conceptual framework and foundation of cancer staging in the era of precision molecular oncology. The AJCC promulgates best staging practices through each new edition in an effort to provide cancer care providers with a powerful, knowledge-based resource for the battle against cancer. In this commentary, the authors highlight the overall organizational and structural changes as well as "what's new" in the Eighth Edition. It is hoped that this information will provide the reader with a better understanding of the rationale behind the aggregate proposed changes and the exciting developments in the upcoming edition. CA Cancer J Clin 2017;67:93-99. © 2017 American Cancer Society.

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

“…1 Changes for the eighth edition were based on evidence available from peer-reviewed literature and on findings from large, as yet unpublished databases and were carefully reviewed by a panel of breast cancer experts and AJCC representatives.…”

The American Joint Commission Cancer 8th Edition Prognostic Stage Including Oncotype DX® Recurrence Score: Impact on Staging of Early Breast Cancer

“…However, recent advances in our understanding of the impact of biological indices on prognosis and likely response to therapy have highlighted shortcomings in a purely anatomic-based staging classification system. In an attempt to address this deficit, the AJCC 8th edition has developed a PS that combines histological tumour grade, biomarker status, and the results of the Oncotype DX® 21 multigene assay, in a subset of patients, with AS to more accurately stratify BC patients according to prognosis and to further facilitate personalised treatment planning [1-3]. The PS was developed based on a review of the current literature and on an unpublished analysis, by one of the AJCC breast panel members, of 238,265 women diagnosed in 2010 who were included in the US database.…”

“…The recently published American Joint Commission on Cancer (AJCC) Cancer Staging Manual, 8th edition [1], introduced into United States clinical practice in January 2018, proposes a new breast cancer (BC) Prognostic Stage (PS) that combines histological tumour grade, oestrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor-2 (HER2) receptor status with traditional Anatomic TNM Stage (AS) [2, 3]. In a further modification, patients with ER-positive, HER2-negative, lymph node (LN)-negative BC, and an Oncotype DX® recurrence score (RS) of < 11 are assigned to PS 1A irrespective of histological grade and tumour size up to 5 cm.…”

Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition)

“…Chinese version of mediastinal lymph node map for thoracic esophageal squamous cell carcinoma At present, both the lymph node maps of the American J o i n t C o m m i t t e e o n C a n c e r ( A J C C ) / U n i o n f o r International Cancer Control (UICC) nomenclature (16)(17)(18) and the Japan Esophageal Society (JES) are commonly used in China for thoracic lymph nodes dissection in esophageal cancer (19,20). Major differences exist in N staging between the two systems; with the AJCC/UICC system, N staging is based on the number of lymph node metastases, while with the JES system, it is based on the region (i.e., the classified station) in which the metastatic lymph nodes are located.…”