American Joint Committee On Cancer 8th Edition Research Articles

Establishment of a nomogram model for predicting distant metastasis in pancreatic ductal adenocarcinoma: a comparative analysis of different lymph node staging systems based on the SEER database

The purpose of this study was to compare the predictive value of different lymph node staging systems and to develop an optimal prognostic nomogram for predicting distant metastasis in pancreatic ductal adenocarcinoma (PDAC). Our study involved 6364 patients selected from the Surveillance, Epidemiology, and End Results (SEER) database and 126 patients from China. Independent risk factors for distant metastasis were screened by univariate and multivariate logistic regression analyses, and a model-based comparison of different lymph node staging systems was conducted. Furthermore, we developed a nomogram for predicting distant metastasis using the optimal performance lymph node staging system. The lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), age, primary site, grade, tumor size, American Joint Committee on Cancer (AJCC) 7th Edition T stage, and radiotherapy recipient status were significant predictors of distant metastasis in PDAC patients. The model with the LODDS was a better fit than the model with the LNR. We developed a nomogram model based on LODDS and six clinical parameters. The area under the curve (AUC) and concordance index (C-index) of 0.753 indicated that this model satisfied the discrimination criteria. Kaplan–Meier curves indicate a significant difference in OS among patients with different metastasis risks. LODDS seems to have a superior ability to predict distant metastasis in PDAC patients compared with the AJCC 8th Edition N stage, PLN and LNR staging systems. Moreover, we developed a nomogram model for predicting distant metastasis. Clinicians can use the model to detect patients at high risk of distant metastasis and to make further clinical decisions.

Eyelid/Periocular Sebaceous Gland Carcinoma in 500 Eyes: Analysis based on 8th Edition American Joint Cancer Committee Classification

PurposeTo analyze the presentation and outcomes of eyelid and periocular sebaceous gland carcinoma (SGC) based on prognostic stage of the 8th edition of American Joint Committee on Cancer (AJCC) classification. DesignRetrospective clinical cohort study Methods• Setting: Quaternary referral center• Study population: 500 eyes of 499 patients with SGC• Intervention: Excisional biopsy, chemotherapy, Orbital exenteration• Main outcome measures: Tumor recurrence, lymph node metastasis, systemic metastasis, and death based on AJCC prognostic staging ResultsThe mean age at presentation with SGC was 57 years (55 years; range, 26 to 82 years). Based on the 8th edition of AJCC classification, tumors belonged to Stage 0 (n=13, 3%), I (n=158, 32%), II (n=269, 54%), III (n=48, 9%), and IV (n=12, 2%). At a mean follow-up of 26 months (median, 10 months; range, <1 to 192 months), tumor recurrence, lymph node metastasis, systemic metastasis, and disease-related death were seen in 39 (10%), 65 (16%), 33 (8%), and 33 (8%) patients respectively. Tumor recurrence rates did not differ significantly between the stages (p=0.472). The 5-year Kaplan-Meier estimates of regional lymph node metastasis, systemic metastasis, and metastasis-related death were higher for stage II (12%, 11%, and 12%, respectively), III (69%, 25%, and 42%, respectively) and IV (70%, 100%, and 100%, respectively) compared to stage I (0%, 6%, and 6%, respectively). Cox proportional analysis revealed a greater hazard ratio (HR) for lymph node metastasis in stage II (HR, 3.498; 95% CI, 0.200 to 10.200; p<0.022), III (HR, 95% CI, 24.836; 8.733 to 70.631; p<0.001), and IV (HR, 53.731; 95% CI, 15.418 to 187.253; p<0.001), systemic metastasis in stage III (HR. 13.895; 95% CI, 3.871 to 49.874; p<0.001) and IV (HR, 81.465; 95% CI, 22.267 to 298.051; p<0.001) and for disease-related death in stage III (HR, 9.182; 95% CI, 2.743 to 30.728; p<0.001) and IV (HR, 85.237; 95% CI, 25.331 to 287.422; p<0.001), compared to stage I. ConclusionThe prognostic staging of the 8th edition AJCC classification predicts the prognosis of patients with eyelid and periocular SGC, which worsens with the advancing stage. The high incidence of lymph node and systemic metastasis accounts for mortality in these patients.

Traversing the Terrain: Potential Pitfalls within the AJCC 8th Edition Staging System for Lip and Oral Cavity Cancers.

In 1977, the American Joint Committee on Cancer (AJCC) introduced the inaugural Cancer Staging Manual, which implemented the T (tumor extent), N (regional lymph node status), and M (presence or absence of distant metastasis) staging system. This systematic approach aimed to convey the extent of disease across various cancer types, providing clinicians with a practical framework to plan treatment strategies, predict prognosis, and assess outcomes. The AJCC 8th edition, effective from January 1, 2018, continues this tradition. However, certain shortcomings persist in the AJCC 8th edition, as identified through clinical experience. Specifically, challenges arise in accurately assessing depth of invasion in unique histological variants of oral squamous cell carcinoma (e.g., Oral verrucous carcinoma, Carcinoma cuniculatum, and Papillary squamous cell carcinoma) and minor salivary gland tumors. Additionally, discrepancies exist in the perception of bone invasion patterns and in reporting practices. There is also a need for staging guidelines for malignant odontogenic tumors and multifocal tumors of the oral cavity, supplemented by diagrammatic representations. Lastly, there is a call for comprehensive staging criteria for carcinomas of the ear, external auditory canal, and temporal bone. We advocate for the inclusion of these considerations in future editions of the AJCC Cancer Staging Manual.

Abstract PO5-27-01: Comparison between the 7th and the 8th edition of TNM Staging System of American joint committee on Cancer(AJCC) for Breast Cancer Patients, diagnosed and treated at King Abdulaziz Medical City

Abstract Breast cancer is a heterogeneous disease with different biological and molecular characteristics that affect local recurrence, metastases, prognoses, and response to available therapies. The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer has incorporated the biological and molecular characteristics, tumor grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor status(Her-2)and tumor grade, into the traditional anatomical 7th edition that only considers tumor size, lymph nodes status, and distant metastases. The aim of this study is to compare the 7th to 8th editions of the AJCC staging system for prognostic impact, assess the effect of the new edition on the treatment and treatment outcome Method A retrospective cohort study was performed for all breast cancer patients, diagnosed between (2013 -2019) and underwent upfront surgery at King Abdulaziz Medical City (KAMC).Patients’ clinicopathological, immunohistochemical, surgical, therapeutic, and follow-up data were retrieved. Overall survival (OS) and breast cancer-specific survival (BCSS) were estimated using the Kaplan–Meier method. Univariate analysis using Fisher's exact test was used to compare staging systems' prognostic accuracy. Multivariable analysis using Cox proportional hazards regression analysis was performed to identify factors independently associated with disease outcome Results A total of 169 female patients were included, the 8th AJCC staging system resulted in a reallocation of 108 (63.9%) of the patients to a different stage group. The majority were downstaged(60.9%) while only 3% were upstaged, most of the upstaged patients had a triple-negative subtype (80%). The change in overall stage for the 8th edition was most significant in stage I (an increase by 140.3%), followed by stage II (downstaged by 74.3%) and stage III (downstaged by 49.7%) compared to the 7th edition. Critically 42.8% of all downstaged patients treated with adjuvant chemotherapy were found to have received unnecessary chemotherapy after applying the 8th AJCC staging system as per National Comprehensive Cancer Network (NCCN) clinical practice guidelines recommendations. The 8th AJCC staging system was a better prognostic predictor of disease survival, patients in 8th AJCC stage 3 had a higher tendency to develop metastases and die because of their disease (P-value 0.03, 0.051, respectively). Conclusions: Our comparison revealed that the AJCC 8th edition staging system is superior and more comprehensive than the 7th, in term of prognostic value, and in defining the precise adjuvant therapy Figure 1 Comparison of the 7th AJCC and the 8th AJCC staging system Citation Format: Nafisa Abdelhafiez, Abdulmohsen Alkushi, Lolwah Alriyees, Mohammad Arabi, Faris Alsalamah, Emad Masuadi, Ahmad Omair, Mohammad Alkaiyat, Hussam Shehata. Comparison between the 7th and the 8th edition of TNM Staging System of American joint committee on Cancer(AJCC) for Breast Cancer Patients, diagnosed and treated at King Abdulaziz Medical City [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-27-01.

Abstract PO3-15-08: Validation for prognostic staging based AJCC 8th edition with nuclear grade in Japanese breast cancer patients: A multicenter retrospective study

Abstract Introduction. The American Joint Committee on Cancer (AJCC) 8th edition of breast cancer classification introduced the concept of "prognostic stage," which is based on anatomic classification (TNM classification) plus four biomarkers: estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2), and histological grading (HG). In Japan, however, the introduction of histological classification has been passive and slow, and the nuclear grading (NG) has been used so far. Objective. Our aim is to compare the prognostic staging classification in the AJCC, 8th edition which substitutes NG for HG (AJCC8th-NG) with the TNM classification, and to confirm the usefulness of AJCC8th-NG classification. Methods. We collected 5229 patients with primary breast cancer operated on between 2005 and 2013 at six institutions affiliated with Kyushu University Hospital in Japan, for whom prognosis was available. We retrospectively evaluated the 7-year survival rates based on the TNM classification and the AJCC8th-NG classification, based on the pathological diagnosis of their surgeries. Results. Median age was 58 years (24-99), 5210 (99.6%) were female, and the 7-year survival rate of all eligible patients was 93.2%. The changes in the number of cases by stage were observed as follows: Stage 0 (16.5%), Stage IA (42.3% to 56.2%), Stage IB (0.3% to 8.8%), Stage IIA (21.5% to 6.9%), Stage IIB (9.7% to 3.1%), Stage IIIA (3.9% to 3.5%), Stage IIIB (1.5% to 1.9%), Stage IIIC (2.1% to 0.9%), Stage IV (1.9%). The changes in 7-year survival rates were observed as follows: Stage 0 (96.1%), Stage IA (96.8% → 96.5%), Stage IB (93.7% → 93.4%), Stage IIA (93.1% → 87.8%), Stage IIB (88.5% → 84.6%), Stage IIIA (86.9% → 80.4%), Stage IIIB (78 .7% to 84.4%), Stage IIIC (79.8% to 58.4%), and Stage IV (51.9%). (TNM classification →AJCC8th-NG classification) Both TNM classification and AJCC8th-NG classification were significantly associated with prognosis. AJCC8th-NG classification was more stratified. In AJCC 8th-NG Stage IB, which is the largest population in all patients, 42% of that were triple-negative type (TN) downstaging from TNM Stage IA and 58% were luminal type downstaging from TNM Stage II-IIIA. In AJCC 8th-NG Stage IIIC, which was changed the most with biomarkers, 52% of that were TN upstaging from TNM Stage IIIA-IIIB. On the other hand, 50% of AJCC 8th-NG Stage IIIB with a favorable prognosis were ER-positive or HER2-positive downstaged from TNM Stage IIIC. Discussion TN breast cancer generally has a poor prognosis. However, HER2-positive breast cancer, which used to have a poor prognosis, is said to have a favorable prognosis after the availability of anti-HER2 drugs. This time, we examined cases after 2005 when anti-HER2 drugs became available in Japan, but the results did not show that HER2-positive breast cancer had a better prognosis than HER2-negative breast cancer. In this study, we were unable to confirm the use of anti-HER2 drugs. In the AJCC 8th classification, it seems necessary to consider whether or not treatment is being provided. If all patients are treated, the prognostic stratification will become clearer. Conclusion. Our study could show that AJCC8th-NG classification was useful for predicting prognosis same as AJCC8th classification in the relatively large cohort. Citation Format: Kazuhisa Kaneshiro, Mai Yamada, Saori Hayashi, Kenichiro Koga, Michiyo Saimura, Naoki Otomo, Shuyo Umeda, Keisei Anan, Masayuki Okido, Takafumi Morisaki, Masafumi Nakamura, Makoto Kubo. Validation for prognostic staging based AJCC 8th edition with nuclear grade in Japanese breast cancer patients: A multicenter retrospective study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-15-08.

Utilizing the AJCC 8th Staging to Discriminate Survival Outcomes in HPV-associated Oropharyngeal Squamous Cell Carcinoma.

The American Joint Committee on Cancer (AJCC) staging 8th edition introduced major changes in the TNM staging of oropharyngeal squamous cell carcinoma (OPSCC) based on the human papillomavirus (HPV) status. This study aimed to observe how well the AJCC staging 8th edition precisely discriminates survival outcomes in patients with HPV-associated OPSCC using a large population database. Using the Surveillance, Epidemiology, and End Results database between 2010 and 2016, 7,448 patients with HPV-associated OPSCC were enrolled. Patients diagnosed with OPSCC and tested positive for HPV with information on the TNM staging according to the AJCC staging 7th edition were selected. Next, T-, N-, and clinical staging were reconstructed based on the AJCC staging 8th edition. Survival probabilities in both AJCC staging 7th and 8th editions were estimated and compared. Most patients (93.44%) were down-staged from the 7th to the 8th edition. The AJCC staging 8th edition showed more discriminatory power in predicting survival of patients with HPV-associated OPSCC than the AJCC staging 7th edition, regardless of the primary subsites. Additionally, clinical stage I patients with HPV-associated OPSCC according to the AJCC 8th edition showed better prognosis in case of high T staging than high N staging. Clinical staging according to the AJCC 8th edition compared to that of the 7th edition was an independent prognostic factor in patients with HPV-associated OPSCC. This study emphasizes the advantages of the new classification system for discriminating survival in HPV-associated OPSCC according to various factors.

Subserosal Layer and/or Pancreatic Invasion Based on Anatomical Features as a Novel Prognostic Indicator in Patients with Distal Cholangiocarcinoma.

The American Joint Committee on Cancer (AJCC) 8th edition T-staging system for distal cholangiocarcinoma (DCC) proposes classification according to the depth of invasion (DOI); nevertheless, DOI measurement is complex and irreproducible. This study focused on the fibromuscular layer and evaluated whether the presence or absence of penetrating fibromuscular invasion of DCC contributes to recurrence and prognosis. In total, 55 patients pathologically diagnosed with DCC who underwent surgical resection from 2002 to 2022 were clinicopathologically examined. Subserosal layer and/or pancreatic (SS/Panc) invasion, defined as penetration of the fibromuscular layer and invasion of the subserosal layer or pancreas by the cancer, was assessed with other clinicopathological prognostic factors to investigate recurrence and prognostic factors. According to the AJCC 8th edition, there were 11 T1, 28 T2, and 16 T3 cases, with 44 (80%) cases of SS/Panc invasion. The DOI was not significantly different for both recurrence and prognostic factors. In the multivariate analysis, only SS/Panc was identified as an independent factor for prognosis (hazard ratio: 16.1; 95% confidence interval: 2.1-118.8, p = 0.006). In conclusion, while the determination of DOI in DCC does not accurately reflect recurrence and prognosis, the presence of SS/Panc invasion may contribute to the T-staging system.

Preoperative MRI features predicting very early recurrence of intrahepatic mass-forming cholangiocarcinoma after R0 resection: a comparison with the AJCC 8th edition staging system.

This study aimed to establish a nomogram based on preoperative magnetic resonance imaging (MRI) features to predict the very early recurrence (VER, less than 6months) of intrahepatic mass-forming cholangiocarcinoma (IMCC) after R0 resection. This study enrolled a group of 193 IMCC patients from our institution between March 2010 and January 2022. Patients were allocated into the development cohort (n=137) and the validation cohort (n=56), randomly, and the preoperative clinical and MRI features were collected. Univariate and multivariate stepwise logistic regression assessments were adopted to assess predictors of VER. Nomogram was constructed and certificated in the validation cohort. The performance of the prediction nomogram was evaluated by its discrimination, calibration, and clinical utility. The performance of the nomogram was compared with the T stage of the American Joint Committee on Cancer (AJCC) 8th edition staging system. Fifty-three patients (27.5%) experienced VER of the tumor and 140 patients (72.5%) with non-VER, during the follow-up period. After multivariate stepwise logistic regression, number of lesions, diffuse hypoenhancement on arterial phase, necorsis and suspicious lymph nodes were independently associated with VER. The nomogram demonstrated significantly higher area under the curve (AUC) of 0.813 than T stage (AUC=0.666, P=0.006) in the development cohort, whereas in the validation cohort, the nomogram showed better discrimination performance, with an AUC of 0.808 than T stage (0.705) with no significantly difference (P=0.230). Decision curve analysis reflected the clinical net benefit of the nomogram. The nomogram based on preoperative MRI features is a reliable tool to predict VER for patients with IMCC after R0 resection. This nomogram will be helpful to improve survival prediction and individualized treatment.

The Effect of Clinical (Anatomical) and Prognostic Stage Groups on Survival in Patients Diagnosed with Breast Cancer: MULTI-Center Study Results, TROD Breast Cancer Study Group

The American Joint Committee on Cancer (AJCC) anatomic stage groups have arguably been the most powerful method in predicting breast cancer outcomes. In the present study, we aimed to determine the differences between anatomical stage and clinical prognostic stage groups, which were obtained by adding biological markers such as histologic tumor grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 status to patients diagnosed with breast cancer, the rate of change in stage, and the effect of stage change on survival. The study protocol was sent to all radiation oncology centers in Türkiye. Four centers enrolled their patients to the study. A total of 1470 stage I-III breast cancer patients with complete information on biological markers (histologic tumor grade, hormone receptor, and c-erb B2 receptor status), haven't been treated with neoadjuvant therapy were included to the study and evaluated retrospectively. The 8th edition of AJCC consolidated biological markers in to clinical prognostic stage groups. Kaplan-Meier curves were used to estimate survival. The log-rank test was used to compare the difference between groups. The Cox proportional-hazards regression model was used to determine the association between anatomic-prognostic stage, disease-free survival (DFS), and overall survival (OS). The median follow-up time was 82 (6-237) months. Median age of the patients was 52 years (20-88) and 865 cases (58.8%) were in the postmenopausal period. The axillary lymph node status was negative (N0) in 765 patients (52.1%). Tumor grade was grade I in 200 patients (13.6%), grade II in 812 patients (55.2%) and grade III in 452 patients (30.7%). Estrogen receptor status was positive in 1247 patients (84.8%), PR status was positive in 1178 patients and Her2-neu status was positive in 207 patients (14.1%). A stage change has been identified in a total of 777 patients (52.9%). Compared with the anatomic stage groups, application of the clinical prognostic stage groups assigned 46.4% cases lower and 6.5% cases higher stage. Five- and ten-year OS and DFS rates of the patients are 73.7%, 44.3% and 91.9%, 86.3% respectively. Age (p<0.001), tumor grade (p<0.001), ER status (p<0.001), PR status (p<0.001), cerbB2 receptor status (p = 0.025) were found to be statistically significant variables in multivariable analysis for OS. For DFS, multivariable analysis showed that age (p = 0.027), tumor grade (p = 0.005), anatomical stage (p<0.001) and assigned to higher stage (p = .001) were statistically significant variables. Hormone receptors and c-erb B2 receptor status are independent variables which impact OS and DFS in our patient group which is mostly consisted of early-stage cases according to anatomical stage. In prognostic staging, upstaging stands out as an independent prognostic factor for DFS. The 8th edition of AJCC prognostic stage groups determines the prognosis much better in our patient cohort.

Long-Term Survival of American Joint Committee on Cancer 8th Edition Staging Descriptors for Clinical M1a Non-Small Cell Lung Cancer

The American Joint Committee on Cancer (AJCC) 8th Edition TNM staging manual for non-small cell lung cancer (NSCLC) M1a descriptors includes tumors seen with malignant pleural or pericardial effusion (ie, M1a-Effusion), pleural or pericardial nodule(s) (ie, M1a-Pleural), or separate tumor nodule(s) in a contralateral lobe (ie, M1a-Contralateral). Is M1a NSCLC seen with malignant pleural or pericardial effusion associated with worse survival compared with other types of M1a NSCLC? Patients with cT1-4, N0-3, M1a NSCLC (satisfying a single M1a descriptor of M1a-Effusion, M1a-Pleural, or M1a-Contralateral), according to AJCC 8th edition staging criteria, in the National Cancer Database from 2010 to 2015 were included. Overall survival was evaluated by using Kaplan-Meier analysis, multivariable-adjusted Cox proportional hazards modeling, and propensity score matching. Of the 25,716 patients who met study eligibility criteria, 12,756 (49.6%) presented with M1a-Effusion tumors, 3,589 (14.0%) with M1a-Pleural tumors, and 9,371 (36.4%) with M1a-Contralateral tumors. In multivariable-adjusted analysis, M1a-Effusion tumors were associated with worse overall survival than M1a-Pleural tumors (hazard ratio [HR], 1.48; 95%CI, 1.40-1.56; P< .001) and M1a-Contralateral tumors (HR: 1.51; 95%CI, 1.46-1.57; P< .001). No significant differences were found in overall survival between patients with M1a-Pleural tumors vsM1a-Contralateral tumors (HR, 0.98; 95%CI, 0.93-1.03; P= .42). In a propensity score-matched analysis of 5,581 patients with M1a-Effusion tumors and 5,581 patients with other M1a tumors (ie, M1a-Contralateral or M1a-Effusion), those with M1a-Effusion tumors had worse 5-year overall survival than patients with other M1a tumors (M1a-Effusion 6.4%[95%CI, 5.7-7.1] vsM1a-Other 10.6%[95%CI, 9.7-11.5]; P< .001). In this national analysis of AJCC 8th Edition cT1-4, N0-3, M1a NSCLC, tumors with malignant pleural or pericardial effusion were associated with worse overall survival than those with either pleural or contralateral pulmonary nodules. These findings may be taken into consideration for the upcoming 9th edition of the lung cancer staging guidelines.

Positive margin and advanced depth of invasion as the indicators for assessing the necessity of adjuvant chemoradiotherapy in early-stage oral cavity squamous cell carcinoma.

e18052 Background: Adjuvant therapy was indicated for patients with a high risk of disease progression after curative therapy, and RTOC 9501/EORTC 22931 were the landmark studies for assessing the necessity of adjuvant therapy in oral cavity squamous cell carcinoma (OCSCC). However, the role of adjuvant therapy in early-staging OCSCC, which was redefined by the 8th edition American Joint Committee on Cancer (AJCC) staging system, was unknown. Methods: A total of 485 early-staging OCSCC patients (pT1-2N0) diagnosed between Jan 2010 and Dec 2019 were retrospectively enrolled. All of them were newly diagnosed and reevaluated to meet the criteria of the 8th edition AJCC staging system. Adjuvant therapy was discussed and concluded in the combined conference of the head and neck multidisciplinary team at Chung Shan Medical University Hospital. And the enrolled patients were divided into the groups with or without adjuvant therapy. The effectiveness of adjuvant therapy and prognostic factor for locoregional recurrence-free survival (LRFS) were analyzed. Results: Nearly one-sixth (16.1%, 78/485) of the enrolled patients received adjuvant therapy. The patients with adjuvant therapy were worse in pathologic T staging ( P &lt; 0.001), histologic grade ( P &lt; 0.001), and pathologic features (depth of invasion [DOI] &gt; 4mm, P &lt; 0.001; perineural invasion, P &lt; 0.001) than those without. Positive margin and advanced DOI ( &gt; 4mm) were the independent factors for LRFS. Adjuvant therapy did not improve LRFS that the 3-year LRFS of the patients with or without adjuvant therapy were 79.7% and 81.5%, respectively ( P = 0.718)(hazard ratio [HR], 95% confidence interval [CI]: 1.10 [0.67-1.80]). However, adjuvant chemoradiotherapy (CRT) indeed prolonged LRFS in some subgroups, such as those with positive margin or advanced DOI (the subgroup with positive margin, 3-year LRFS of those with or without adjuvant therapy, 100% and 58.8%, HR[95% CI]: 0.04[0.00-267.330]; the subgroup with advanced DOI, 3-year LRFS, 83.3% and 73.1%, HR[95% CI]: 0.48[0.16-2.01]). In addition to positive margin, advanced DOI was the most critical correlation coefficient factor among the pathologic features, including pathologic T staging, perineural invasion, lymphovascular invasion, poorly differentiated, and close margin. For the patients eligible for evaluation, forty percent (40.1%, 180/439) of the patients were diagnosed with positive margins or advanced DOI and these patients might be considered to receive adjuvant CRT in the future. Conclusions: Positive margin and DOI were the most important indicators to evaluate the necessity of adjuvant CRT in early-staging OCSCC. Future warranted studies were needed.

Clinicopathological Profile of Ampulla of Vater and Pancreas Malignancies at Cipto Mangunkusumo Hospital in 2015-2019

Background&#x0D; Malignancies of ampulla of vater and pancreas are often difficult to distinguish. Malignancies in ampulla of vater include malignancies in major duodenal papilla, distal common bile duct and pancreatic duct opening (Wirsung). The origin of the primary tumor, histopathological diagnosis and staging play a role in therapy and prognosis. WHO Classification of tumors of the digestive system, 2019 made changes in tumor staging following the system of the American Joint Committee on Cancer (AJCC), 8th edition. This study was conducted to determine types of pancreatic and ampullary malignancies, demographic distribution, location, profile, histomorphology and tumor staging changes in the 7th edition of the AJCC to 8th edition of the AJCC in the WHO Classification of tumors of the digestive system, 2019. The aim to determine clinicopathological profile of malignancies of ampulla of vater and pancreas as well as tumor staging changes based on AJCC edition 8.&#x0D; Methods&#x0D; Observational descriptive study on pancreatic and ampulla vater malignancy resection preparations at Department of Anatomic Pathology FKUI/RSCM, period January 2015 to December 2019 that met the inclusion criteria. Demographic evaluation, tumor location, histopathological profile and patient staging changes were carried out based on the 8th edition of AJCC.&#x0D; Results&#x0D; There were 27 cases of adenocarcinoma in ampulla of vater, 10 cases of pancreatic ductal adenocarcinoma, 1 case of mucinous cystic neoplasm with adenocarcinoma focus, 1 case of serous cystadenocarcinoma, 7 cases of PanNET, 2 cases of PanNEC, 3 cases of SPN, 1 case of MiNEN. Changes in pT were present in 29 cases. Changes in pN were present in 6 cases.&#x0D; Conclusion&#x0D; The diagnosis and pathological staging are in accordance with the 2019 WHO digestive system tumor classification. Tumor differentiation, presence or absence of lymphovascular invasion, perineural invasion and lymph node metastases and incision margin status are important histopathological parameters.

Retrospective analysis of 8th edition American Joint Cancer Classification: Distal cholangiocarcinoma.

This is a retrospective analysis of whether the 8th edition American Joint Committee on Cancer (AJCC) was a significant improvement over the 7th AJCC distal extrahepatic cholangiocarcinoma classification. In total, 111 patients who underwent curative resection of mid-distal bile duct cancer from 2002 to 2019 were included. Cases were re-classified into 7th and 8th AJCC as well as clinicopathological univariate and multivariate, and Kaplan-Meier survival curve and log rank were calculated using R software. In patient characteristics, pancreaticoduodenectomy/pylorus preserving pancreaticoduodenectomy had better survival than segmental resection. Only lymphovascular invasion was found to be significant (hazard ratio 2.01, p = 0.039) among all clinicopathological variables. The 8th edition AJCC Kaplan Meier survival curve showed an inability to properly segregate stage I and IIA, while there was a large difference in survival probability between IIA and IIB. The 8th distal AJCC classification did resolve the anatomical issue with the T stage, as T1 and T3 showed improvement over the 7th AJCC, and the N stage division of the N1 and N2 category was found to be justified, with poorer survival in N2 than N1. Meanwhile, in TMN staging, the 8th AJCC was able differentiate between early stage (I and IIA) and late stage (IIB and III) to better explain the patient prognosis.

MP64-18 RECLASSIFICATION OF PATHOLOGICALLY UPSTAGED T3A RENAL CELL CARCINOMA IS LINKED WITH ENHANCED ALIGNMENT OF OUTCOMES: ANALYSIS OF THE NATIONAL CANCER DATABASE

You have accessJournal of UrologyCME1 Apr 2023MP64-18 RECLASSIFICATION OF PATHOLOGICALLY UPSTAGED T3A RENAL CELL CARCINOMA IS LINKED WITH ENHANCED ALIGNMENT OF OUTCOMES: ANALYSIS OF THE NATIONAL CANCER DATABASE Dhruv Puri, Luke Wang, Margaret Meagher, Aastha Shah, Franklin Liu, Saeed Ghassemzadeh, Mimi Nguyen, Kevin Hakimi, Cesare Saitta, Jonathan Afari, Sohail Dehanji, Ryan Nasseri, Juan Javier-Desloges, and Ithaar Derweesh Dhruv PuriDhruv Puri More articles by this author , Luke WangLuke Wang More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Aastha ShahAastha Shah More articles by this author , Franklin LiuFranklin Liu More articles by this author , Saeed GhassemzadehSaeed Ghassemzadeh More articles by this author , Mimi NguyenMimi Nguyen More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Jonathan AfariJonathan Afari More articles by this author , Sohail DehanjiSohail Dehanji More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pathological upstaging to pT3a disease can occur after surgical treatment of clinical T1 and T2 Renal Cell Carcinoma (RCC), and upstaging to T3 RCC is associated with poorer outcomes. Nonetheless pT3a RCC is a heterogeneous group with a wide variance in outcomes. With an intent to delve deeper into the disparateness in outcomes of pT3a disease, we investigated the outcomes of patients with an initial clinical stage of cT1, cT2 and cT3a. METHODS: Using the National Cancer Database, patients with RCC were categorized by pathological and clinical staging of RCC according to American Joint Committee on Cancer (AJCC) criteria. The primary outcome was measured as overall survival (OS). Kaplan-Meier Analysis (KMA) assessed differences between cT1 upstaged to pT3a RCC (cTa→pT3a), cT2 upstaged to pT3a RCC (cT2→pT3a), clinical/pathological T2 RCC (cT2→pT2), and clinical/pathological T3a RCC (T3a → pT3a). Multivariable cox regression (MVA) assessed predictors for OS evaluating clinical and pathological disease status. ROC/AUC analysis was utilized to compare predictive value of AJCC 8th edition TNM staging vs proposed staging. RESULTS: 53741 patients with pT3a disease were analyzed (10785 cT1→pT3a; 9675 cT2→pT3a, 22025 cT2→pT2; and 11256 cT3a→pT3a). MVA for OS [cT1→pT3a (referent)] demonstrated that cT2→pT3a (HR=1.33, p<0.001) and cT3a→pT3a (HR=1.35, p<0.001) were associated with worsened OS, while cT2→pT2 (HR=0.96, p=0.05) was not significantly different from referent. KMA revealed a difference in 5-year OS (cT1→pT3a 73.1%; cT2→pT2 78.0%; cT2→pT3a 60.8%; and cT3a→pT3a 59.9%, p<0.001). As such we proposed to align cT1→pT3a and cT2→pT2 into a new pT2 group while maintaining cT2→pT3a and cT3a→pT3a in a new pT3a (5 year OS new pT2 vs. new pT3a: 78.0% vs. 60.3%, p=0.003). ROC analysis revealed an AUC of 0.500 (p=0.005) for OS using the current AJCC 8th edition TNM staging and an AUC of 0.563 (p=0.003) for OS for our new proposal. CONCLUSIONS: Reclassification of cT1→pT3a and cT2→ pT2 into a new pT2 RCC while maintaining cT2→ pT3a and cT3a→pT3a RCC as a new pT3a RCC resulted in improved performance of realigned model for OS. Revision of TNM criteria for T2 and T3a RCC may lead to improved predictive ability and less heterogeneity in outcomes. Source of Funding: Insitutional © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e888 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhruv Puri More articles by this author Luke Wang More articles by this author Margaret Meagher More articles by this author Aastha Shah More articles by this author Franklin Liu More articles by this author Saeed Ghassemzadeh More articles by this author Mimi Nguyen More articles by this author Kevin Hakimi More articles by this author Cesare Saitta More articles by this author Jonathan Afari More articles by this author Sohail Dehanji More articles by this author Ryan Nasseri More articles by this author Juan Javier-Desloges More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparing the predictive performance of different lymph node staging systems for postoperative overall survival in patients with ampullary carcinoma.

This study was to analyze and compare the predictive performance of the 7th and the 8th edition American Joint Committee on Cancer (AJCC) N staging system, lymph nodes ratio (LNR) and log odds of positive lymph node (LODDS) for the survival of patients with ampullary carcinomas (ACs). This retrospective cohort study included patients with primary ACs after surgery from the Surveillance, Epidemiology, and End Results (SEER) 2004-2015. Univariate and multivariate Cox proportional hazard models were used. The study population was divided into a training set and a testing set in a ratio of 7-3. The C-index and area under the curve (AUC) were used to compare the predictive performance of the four staging on overall survival (OS) in the training set and the testing set. A total of 7,480 patients with primary ACs (1,178 survived and 1,128 dead) were in this study. The average follow-up time was 41.1 months. N1 stage and N2 stage of the 8th edition AJCC N staging system, LNR staging (0-0.3), LNR (>0.3), LODDS (-2.4 to -0.8) and LODDS (>-0.8) were associated with OS in AC patients after adjusting for age, race, pT stage, tumor size, grade, radiation, and insurance. The C-index of the 7th AJCC N staging was significantly lower than the C-index of the 8th AJCC N staging in the training set [0.608 vs. 0.629, P < 0.001] and testing set [0.635 vs. 0.658, P < 0.001]. The C-index of the LODDS staging was significantly higher than the C-index of the 8th AJCC N staging in the training set [0.641 vs. 0.629, P = 0.034] and testing set [0.671 vs. 0.658, P = 0.034]. LODDS staging may be a potential predictor of OS at 6 months [AUC = 0.687], 12 months (AUC = 0.692), and 48 months (AUC = 0.709), and LNR staging (AUC = 0.655) may be a potential predictor of OS at 24 months in AC patients. The predictive ability of LNR staging and LODDS staging were also found in different subgroups. The LNR and LODDS staging systems' predictive performance for OS of AC patients were superior to the 8th edition AJCC N staging system, especially in patients ages ≥65 or with higher tumor grade (grade II and III). The LNR staging and the LODDS staging were potential predictors for 24-month OS, and 6, 12, 24 and 48-month OS, respectively.

A novel preoperative inflammation score system established for postoperative prognosis predicting of intrahepatic cholangiocarcinoma

BackgroundInflammation is implicated in tumorigenesis and has been reported as an important prognostic factor in cancers. In this study, we aimed to develop and validate a novel inflammation score (IFS) system based on 12 inflammatory markers and explore its impact on intrahepatic cholangiocarcinoma (ICC) survival after hepatectomy.MethodsClinical data of 446 ICC patients undergoing surgical treatment were collected from the Primary Liver Cancer Big Data, and then served as a training cohort to establish the IFS. Furthermore, an internal validation cohort including 175 patients was used as internal validation cohort of the IFS. A survival tree analysis was used to divide ICC patients into three groups (low-, median-, and high- IFS-score groups) according to different IFS values. Kaplan-Meier (KM) curves were used to compare the overall survival (OS) and recurrence-free survival (RFS) rates among three different groups. Cox regression analyses were applied to explore the independent risk factors influencing OS and RFS.ResultsIn the training cohort, 149 patients were in the low-IFS-score group, 187 in the median-IFS-score group, and 110 in the high-IFS-score group. KM curves showed that the high-IFS-score group had worse OS and RFS rates than those of the low- and median-IFS-score groups (P < 0.001) in both the training and validation cohorts. Moreover, multivariable Cox analyses identified high IFS as an independent risk factor for OS and RFS in the training cohort. The area under the curve values for OS prediction of IFS were 0.703 and 0.664 in the training and validation cohorts, respectively, which were higher than those of the American Joint Committee on Cancer (AJCC) 7th edition TNM stage, AJCC 8th edition TNM stage, and the Child-Pugh score.ConclusionOur results revealed the IFS was an independent risk factor for OS and RFS in patients with ICC after hepatectomy and could serve as an effective prognostic prediction system in daily clinical practice.

A multicenter prospective validation study of the 3-cm cut-off in stage I seminoma (S3MI-PT).

TPS435 Background: Testicular germ cell tumors (TGCT) are the most common solid malignancy in men aged 15 to 35, and Seminoma histology can account for up to half of the cases. Since the latest edition of the American Joint Committee on Cancer (AJCC) staging manual (8th edition, 2018), it is recommended that, only in pure Seminoma, the pT1 category should be subdivided according to tumor size: pT1a for tumors &lt; 3 cm or T1b for tumors ≥ 3 cm. This change was based on large retrospective data that suggested almost a doubling of the risk of relapse at 3-years in pT1b versus pT1a, with a Hazard Ratio of 1.87, 95% confidence interval (CI) 1.15-3.06. So far, there has been no prospective validation for these staging changes and there are no known implications of its use in clinical practice. Furthermore, these changes are exclusive for AJCC since the Union for International Cancer Control (UICC), another widely used staging system, did not change from previous editions (i.e., no pT1 subdivision in pure Seminoma). Tumor size was already recognized as a risk factor for relapse (if tumor size &gt; 4 cm) but not formally used for staging before. Of concern, these are mostly young patients, and despite exceptionally good long-term survival rates, in stage I Seminoma, the general estimation of relapse is about 15% but can surpass 30% — therefore accurate prognostic information is particularly important. This study aims to validate the 3 cm cut-off in stage I Seminoma introduced by AJCC 8th edition. Additionally, the study will allow for the evaluation for current trends of adjuvant options (namely surveillance vs active treatment). Methods: S3MI-PT, or Seminoma 3 cm cut-off Prospective Trial, is a multicenter prospective observational validation study that aims to include at least 300 patients (the estimate includes a 10% loss to follow-up rate as TGCT studies are historically difficult to accrue). Eligibility criteria: male patients ≥ 18 years old diagnosed with clinical stage I pure Seminoma histology (pT1N0M0S0), whose orchiectomy must have occurred after January 2018, the AJCC 8th ed. implementation date, who are willing to sign the informed consent. Demographic and clinical data will be collected, that includes, age at diagnosis, tumor size, rete testis invasion, values for TGCT markers, adjuvant treatment options (surveillance or active treatment) and relapse, if applicable. Exclusion criteria: non-pure Seminoma TGCT staged pT2-T4, pN1-N3, M1, S1-3. Primary endpoint is relapse-free survival at 3 years in pT1a versus pT1b, with two-sided P &lt; 0.05 used to determine statistical significance with a 95% CI, by Kaplan-Meier method. S3MI-PT has been approved by the Ethics Committee. The study is actively enrolling, and all individuals and institutions interested in collaborating can do so by request.

Comparing T2-T3 staging of penile cancer according to the American Joint Committee on cancer 8th edition with two modified staging systems in predicting survival outcome: A single-center experience.

Penile cancer is a rare malignancy of the genitourinary tract. We aimed to validate the recent changes in the T2 and T3 stages of penile cancer in the American Joint Committee on Cancer (AJCC) 8th edition and to compare its predictive ability with two other modified staging systems for survival outcomes. This is a retrospective study of patients diagnosed with penile cancer from June 2015 to March 2020. The AJCC 8th edition and two other newly proposed systems by Li et al. and Sali et al. were used for staging the tumor. All variables were categorized and correlated with lymph node (LN) metastases and overall survival (OS). Fifty-four patients were eligible for this study. The mean age was 58 years (range 46-72 years). The tumor stage (P = 0.016), clinical LN stage (P = 0.001), the involvement of the spongiosa (P = 0.015) and the cavernosa (P = 0.002), lymphovascular invasion (LVI) (P = 0.000), and PNI (P = 0.021) were found to be the significant predictors of LN metastases. When the 5 year OS was compared between the T2 and T3 stages of the AJCC 8th edition, Li staging and the Sali staging systems, it was 91% and 50.1% (P = 0.001), 97.5% and 10.3% (P = 0.000), 94.4% and 14.7% (P = 0.000), respectively. The presence of LVI (P = 0.001) was the most significant independent predictor of OS. The recent changes in the AJCC 8th edition pertaining to the T2-T3 stage are relevant, although the other two newly proposed staging systems were more precise in predicting the survival outcomes.

Modified the 8th AJCC staging system for patients with advanced prostate cancer: a study based on SEER database

BackgroundThe American Joint Committee on Cancer (AJCC) 8th staging system of prostate cancer may be insufficient in predicting the prognosis of some staged patients. This study aimed to modify the AJCC 8th staging system in patients with advanced prostate cancer.MethodsData of patients with advanced prostate cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2016 were enrolled in this cohort study. All patients were divided into the training set and the testing set with a ratio of 6:4. Multivariate Cox survival model was utilized to obtain the nomogram score for each stage variable. The modified staging system was based on the total nomogram score. The C-index and Kaplan-Meier (K-M) curves were used to show the prognostic prediction effect of patients with different staging systems.ResultsA total of 28,006 patients were included for analysis. T stage, N stage, M stage, primary Gleason pattern score, secondary Gleason pattern score, and PSA level were included as stage variables. Patients with AJCC stage III C [hazard ratio (HR) = 4.17, 95% confidence interval (CI), 3.39–5.13] and AJCC stage IV B (HR = 3.19, 95%CI, 1.79–5.69) were associated with worse prognosis compared with those of AJCC stage III B, while no statistical significance was found in patients with stage IV A (P > 0.05). In terms of the modified staging system, patients with modified stage III C (HR = 2.06, 95%CI, 1.46–2.92), modified stage IV A (HR = 6.91, 95%CI, 4.81–9.94), and modified stage IV B (HR = 21.89, 95%CI, 14.76–32.46) were associated with a poorer prognosis compared with patients with modified stage III B. The prognostic ability (C-index) of the modified staging system (0.789; 95%CI, 0.777–0.801) was better than that of the AJCC 8th edition system (0.762; 95%CI, 0.748–0.776) (0.789 vs. 0.762, P = 0.004). The K-M curves indicated that the modified staging system may be distinguished prognostic differences in patients with different stages.ConclusionModified staging system may be better than AJCC 8th staging system for predicting prognosis in prostate cancer patients. The AJCC 8th staging system should be further optimized.

The importance of mitosis ≥2 in selecting patients with T1 cutaneous melanomas for sentinel lymph node biopsy.

The 8th Edition of the American Joint Committee on Cancer (AJCC) Staging Manual removed the mitotic rate (MR) as a staging criterion for T1 melanomas, thus leading to a debate on sentinel lymph node biopsy (SLNB) in thin melanomas. This study investigates whether MR plays a role in selecting patients with T1 melanoma for SLNB. We analyzed clinical and histological data from the Florence Melanoma & Skin Cancer Unit database for 313 patients with a single thin melanoma who had undergone SLNB. We determined sentinel lymph node (SLN) positivity percentages in T1 melanomas according to the AJCC 8th Edition focusing on MR. Of the 313 T1 patients, 108 had MR = 0, 127 had MR = 1 and 78 had MR ≥2. The overall SLN positivity rate was 8.6%, (5.6% with MR = 0, 6.3% with MR = 1 and 16.7% with MR ≥2). The SLNB positivity rate in T1b melanomas was 12.1%, (8.5% with MR = 0, 5.7% with MR = 1 and 24.4% with MR ≥2), whereas in T1a melanomas it was 5.8%, (3.3% with MR = 0, 6.8% with MR = 1 and 8.1% with MR ≥2). In a logistic regression analysis, MR ≥2 had an odds ratio of almost three in comparison with MR = 0/1 also adjusting for thickness. Thus, MR ≥2 significantly predicted SLN metastases in T1 melanomas. Of those patients with positive SLN, 37% were classified as T1a according to the AJCC 8th edition. These findings underline the importance of MR ≥2 in selecting patients with T1 cutaneous melanomas for SLNB.