The seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Staging Manuals: The new era of data-driven revisions

Abstract

Effective January 2010, the seventh editions of the American Joint Commission (AJCC) on Cancer and the International Union Against Cancer (UICC) Staging Manuals were published. These result from intensive collaboration between the UICC and the AJCC and unprecedented efforts to develop and analyze large international databases leading to evidence-based revisions of the staging system. It is important for all thoracic surgeons to be aware of these revisions because they directly affect our daily clinical practice. In the previous and current issues of the Journal, Dr Tom Rice and colleagues present ‘‘primers’’ on the new staging systems for lung and esophageal cancer that explain in straightforward terms the revisions made for the seventh edition of the staging manuals. The previous revision of the lung cancer staging system occurred in 1997 with the fifth edition of the staging manuals. It was based on analysis of a relatively small single institution (MD Anderson Cancer Center, Houston, TX) database of 5319 cases of non–small cell lung cancers accumulated since 1975. During the past 15 years, reports from other databases increasingly challenged some of the stage descriptors and groupings. The staging systems for small cell lung cancer and carcinoid tumors were also not clearly addressed in the 1997 revision. These deficiencies were highlighted at an International Association for the Study of Lung Cancer (IASLC) workshop held in London in 1996, prompting the IASLC in 1998 to establish a Lung Cancer Staging Project and Committee, under the leadership of Professor Peter Goldstraw of the Royal Brompton Hospital, London, to bring together large databases available worldwide to form recommendations for the seventh editions of the staging manuals that would be well validated. Cancer Research and Biostatistics (CRAB) in Seattle, Washington, a group with extensive experience managing large clinical trials and databases, agreed to provide biostatistical support