Cancer Staging Manual 8th Edition Research Articles

Association of sociodemographic characteristics with utilization of sentinel lymph node biopsy for American Joint Committee on Cancer 8th edition T1b cutaneous melanoma.

Sentinel lymph node biopsy (SLNB) is an important staging and prognostic tool for cutaneous melanoma (CM). However, there exists a knowledge gap regarding whether sociodemographic characteristics are associated with receipt of SLNB for T1b CMs, for which there are no definitive recommendations for SLNB per current National Comprehensive Cancer Network guidelines. We performed a retrospective analysis of the 2012-2018 National Cancer Database, identifying patients with American Joint Committee on Cancer staging manual 8th edition stage T1b CM, and used multivariable logistic regression to analyze associations between sociodemographic characteristics and receipt of SLNB. Among 40,458 patients with T1b CM, 23,813 (58.9%) received SLNB. Median age was 62years, and most patients were male (57%) and non-Hispanic White (95%). In multivariable analyses, patients of Hispanic (aOR 0.67, 95%CI 0.48-0.94) and other (aOR 0.78, 95%CI 0.63-0.97) race/ethnicity, and patients aged > 75 (aOR 0.33, 95%CI 0.29-0.38), were less likely to receive SLNB. Conversely, patients in the highest of seven socioeconomic status levels (aOR 1.37, 95%CI 1.13-1.65) and those treated at higher-volume facilities (aOR 1.29, 95%CI 1.14-1.46) were more likely to receive SLNB. Understanding the underlying drivers of these associations may yield important insights for the management of patients with melanoma.

Development of a staging system and survival prediction model for advanced gastric cancer patients without adjuvant treatment after curative gastrectomy: A retrospective multicenter cohort study

BackgroundAdjuvant chemotherapy (AC) after curative gastrectomy is the standard treatment for patients with locally advanced gastric adenocarcinoma in East Asia; however, for various reasons, some patients do not receive this treatment. The aim of this study was to develop a system that reflects the survival rate of patients who do not receive AC. Materials and methodsA modified tumor-node-metastasis (TNM) staging system was developed based on the overall survival (OS) of gastric cancer patients after curative gastrectomy without AC at Seoul St. Mary's hospital. A survival prediction model was developed based on the modified staging system and risk factors for OS, which were examined using the Cox proportional hazards regression model. The model was internally validated for the power of prediction and discrimination, compared with the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition; it was externally validated using data from two other tertiary teaching hospitals. ResultsOf the 185 patients in the development set, the 5-year OS rates for modified stages IIA, IIB, IIC, IIIA, and IIIB were 80.2%, 74.0%, 56.7%, 50.0%, and 25.0%, respectively; the median OS intervals for modified stages IIIC and IIID were 21.0 and 11.0 months, respectively. Age, American Society of Anesthesiologists physical status, and postoperative complications were significantly associated with OS. The concordance index (0.768 vs. 0.686), Akaike Information Criterion (745.88 vs. 794.84), and estimated area under the curve (0.7567 vs. 0.6655) were all superior for the prediction model, compared with the AJCC TNM stage. For the validation set of 157 patients, the model performed better for the prediction and discrimination of OS. ConclusionThe newly developed survival prediction model improves the accuracy of OS prediction for stage II and III gastric cancer patients without AC after curative gastrectomy.

Stratification of Postoperative Prognosis by Invasive Tumor Thickness in Perihilar Cholangiocarcinoma.

The pathological tumor classification of distal cholangiocarcinoma in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition is based on invasive depth, whereas that of perihilar cholangiocarcinoma (PHCC) continues to be layer-based. We aimed to clarify whether invasive depth measurement based on invasive tumor thickness (ITT) could help determine postoperative prognosis in patients with PHCC. We enrolled 184 patients with PHCC who underwent hepatectomy plus extrahepatic bile duct resection or hepatopancreatoduodenectomy with curative intent. ITT was measured using simple definitions according to the sectioning direction or gross tumor pattern. The median ITT was 5.8mm (range 0.7-15.5). Using the recursive partitioning technique, ITT was classified into grades A (ITT < 2mm, n = 9), B (2mm ≤ ITT < 5mm, n = 68), C (5mm ≤ ITT < 11mm, n = 81), and D (11mm < ITT, n = 26). The median survival times (MSTs) in patients with grade B, C, or D were 90.8, 44.6, and 21.1months, respectively (patients with grade A did not reach the MST). There were significant differences in postoperative prognosis between ITT grades (A vs. B, p = 0.027; B vs. C, p < 0.001; C vs. D, p = 0.004). Through multivariate analysis, regional node metastasis, invasive carcinoma at the resected margin, and ITT grade were determined as independent prognostic factors. ITT could be measured using simple methods and may be used to stratify postoperative prognosis in patients with PHCC.

Interobserver variability in breast carcinoma grading results in prognostic stage differences

The AJCC Cancer Staging Manual 8th edition included tumor grade in the pathologic prognostic stage for breast carcinomas. Due to the known subjectivity of tumor grading, we aimed to assess the degree of interobserver agreement for invasive carcinoma grade among pathologists and determine its effect on pathologic prognostic stage. One hundred consecutive cases of invasive stage II carcinomas were independently graded twice, with an 4-week intervening wash-out period, by 6 breast pathologists utilizing established Nottingham grading criteria. Inter- and intra-observer variability was determined for overall grade and for each of the 3 scoring components. Interobserver variability was good to very good (κ range = 0.582-0.850) with even better intra-observer variability (mean κ = 0.766). Tubule score was the most reproducible element (κ = 0.588). Complete concordance was reached in 54 cases and 58 cases in rounds 1 and 2 respectively. In round 1 this resulted in different pathologic prognostic stage in only 25 of discordant cases, 18 of which were stage IA versus IB. In conclusion, grading agreement between pathologists was good to very good and discordant grades resulted in small changes to pathologic prognostic stage.

Extramural spread of rectal cancer and the AJCC Cancer Staging Manual 8th edition, 2017

Extramural spread of rectal cancer and the AJCC Cancer Staging Manual 8th edition, 2017

Staging of oropharyngeal squamous cell carcinoma of the head and neck: Prognostic features and power of the 8th edition of the UICC staging manual

IntroductionRecognizing the prognostic power differentiating HPV-associated oropharyngeal squamous cell cancer (OPSCC) from OPSCC with other causes, the UICC Cancer Staging Manual 8th edition realizes significant changes from the 7th edition. Purpose of this study was to evaluate the differences of prognostic impact between the 7th and the latest edition of TNM Classification as well as to examine risk factors like extranodal extension (ENE) and lymph node ratio (LNR) for HPV-mediated OPSCC. Material and methodsThe study includes 255 patients with OPSCC and initial diagnosis between 2008 and 2015. HPV status was determined according to p16 immunohistochemistry (IHC) and all patients were classified as defined by 7th and 8th edition of UICC. Prognostic influence of ENE and LNR was analyzed for patients with HPV-mediated OPSCC. Results41.2% of the OPSCC were p16-positive. Implementation of the 8th edition of the UICC lead to a better differentiation between the respective stages. Regarding HPV-positive OPSCC, Kaplan-Meier survival curves showed a significantly better overall survival (OS) for patients with a LNR ≤10% as well as for patients with negative ENE status (p = 0.004, p = 0.008). Conclusion8th edition of UICC achieves to differentiate properly between the UICC stages. However, the staging rule of ignoring ENE in HPV-mediated OPSCC should be further analyzed. Moreover LNR might be a possible additional prognostic factor – especially regarding HPV-positive tumors.

Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for Perihilar Cholangiocarcinoma

BackgroundThe aim was to compare the prognostic accuracy of cross-sectional imaging of the 7th and 8th editions of the American Joint Committee on Cancer(AJCC) staging system for perihilar cholangiocarcinoma(PHC). MethodsAll patients with PHC between 2002 and 2014 were included. Imaging at the time of presentation was reassessed and clinical tumor–node–metastasis (cTNM) stage was determined according to the 7th and 8th editions of the AJCC staging system. Comparison of the prognostic accuracy was performed using the concordance index (c-index). ResultsA total of 248 PHC patients were included;45 patients(18.1%) underwent a curative-intent resection, whereas 203 patients(81.9%) did not because they were unfit for surgery or were diagnosed with locally advanced or metastatic disease during workup. Prognostic accuracy was comparable between the 7th and 8th editions (c-index 0.57 vs 0.58). For patients who underwent a curative-intent resection, the prognostic accuracy of the 8th edition (0.67) was higher than the 7th (0.65). For patients who did not undergo a curative-intent resection, the prognostic accuracy was poor in both the 7th as the 8th editions (0.54 vs 0.57). ConclusionThe 7th and 8th editions of the AJCC staging system for PHC have comparable prognostic accuracy. Prognostic accuracy was particularly poor in unresectable patients.

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

Background: The American Joint Commission Cancer (AJCC) Cancer Staging Manual 8th edition introduced a breast cancer (BC) Prognostic Stage (PS) that combines tumour grade, oestrogen (ER), progesterone (PgR), and human epidermal growth factor-2 (HER2) receptor status with Anatomic TNM Stage (AS). In a further modification, patients with early BC and an Oncotype DX® Recurrence Score (RS) < 11 are assigned to PS 1A irrespective of grade and size up to 5 cm. This study profiles the impact of these changes on staging in patients with early BC and RS < 11. Methods: A total of 127 patients, with primary BC and RS < 11, were identified from a consecutive series of 729 patients with ER-positive, HER2-negative, lymph node-negative, primary BC whose tumours were tested using the Oncotype DX® 21 multigene assay. Each patient was assigned AS, PS, and RS-modified PS, and staging categories were compared. Results: Applying AS, 100 patients were stage IA and 27 IIA. Applying PS, 89 were stage IA, 33 IB, 4 IIA, and 1 IIB. All patients were IA according to RS-modified PS. Comparing PS to AS, 26.7% of patients (n = 34) changed stage, 9.4% (n = 12) to a higher and 17.3% (n = 22) to a lower stage. RS-modified PS versus AS resulted in downstaging in 21.3% (n = 27). Comparing PS modified by RS to PS alone, 29.9% (n = 38) were downstaged. Conclusion: Application of PS and RS-modified PS results in tumour downstaging in approximately 20% of patients with early BC. Upstaging was observed in 9% of patients when staged according to PS and was primarily due to the impact of high histological grade.

Evaluation of the New American Joint Committee on cancer staging manual 8th edition for perihilar cholangiocarcinoma

Introduction: To evaluate the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (PHC), and to compare the prognostic value of the 7th and 8th editions of the AJCC staging system for PHC. Methods: All patients with PHC between 2002-2014 were included. Imaging at the time of presentation was reassessed and AJCC Tumor-Nodal-Metastasis (TNM) stage was determined according to the 7th and 8th edition of the AJCC staging system. Overall survival (OS) was estimated using the Kaplan-Meier method. Comparison of the prognostic accuracy of staging systems was performed using the concordance index (c-index) and Brier-score. Results: A total of 248 PHC patients were included. Median OS of the entire cohort was 9.7 months (8.0-11.5). Prognostic accuracy was comparable between the 7th and 8th AJCC staging systems (c-index 0.59 vs 0.58). Prognostic accuracy of the 8th edition was higher in the subgroup of resected patient (0.67), but expanding the staging system with sub-stages lowered the c-index to 0.62. The prognostic accuracy of the AJCC staging system in unresectable patients was poor with a c-index of 0.57 in both the normal and expanded staging system. Conclusions: The 7 th and 8 th editions of the AJCC staging system for PHC have comparable prognostic accuracy. Although developed to be used for resectable and unresectable patients, the discriminative performance in unresectable patients was poor. Therefore, the AJCC staging system may need modifications to improve its prognostic accuracy in patients with unresectable PHC, compromising the majority of patients.

AB058. P030. The 8th versus the 7th edition of the AJCC Cancer Staging Manual in predicting the prognosis of pancreatic ductal adenocarcinoma

Background: The American Joint Committee on Cancer (AJCC) released the AJCC Cancer Staging Manual 8th edition with modifications mainly on the definitions of T3 and N2 stages pancreatic cancer. This study aims to assess its strengths and weaknesses related to the 7th edition AJCC staging system.

Abstract P2-03-05: AJCC prognostic stage including oncotype DX®RS: Impact on breast cancer staging compared with traditional anatomic TNM stage

Abstract INTRODUCTION The recently published AJCC Cancer Staging Manual 8th edition, scheduled to be adopted into clinical practice in January 2018, proposes a new breast cancer (BC) Prognostic stage that includes histological grade, estrogen receptor (ER), progesterone receptor (PR), and HER2 status in addition to the traditional Anatomic TNM stage. In a further modification, patients with ER positive, HER2 negative, lymph node negative BC and an Oncotype DX® recurrence score (RS) of less than 11 will be assigned to Prognostic stage 1A irrespective of histological grade and size (up to 5cm). The changes have been proposed in recognition of the prognostic influence of these parameters and in attempt to improve personalised patient care. The aim of this study is to profile the impact on staging by comparing Prognostic stage, with and without RS, to traditional Anatomic stage, in a series of patients with early BC and an RS of less than 11. METHODS The study population comprised 127 patients with primary BC and an RS of less than 11, derived from a consecutive series of 729 patients with ER positive, Her2 negative, lymph node negative, primary BC whose tumors were tested using the Oncotype DX® multigene assay between November 2011 and December 2016. The median patient age was 57 years (35-78). Pathological tumour size was T1a (n=2), T1b (n=19), T1c (n=79) and T2 (n= 27). Median tumor size was 15mm. Histological tumour grade was grade 1 (n=14), 2 (n=98) and 3 (n=15). Each patient was assigned an Anatomic and Prognostic stage, with and without RS modification, according to the AJCC Classification of Cancer Staging, 8th edition. The three staging categories were compared and the impact on stage profiled. RESULTS Applying the traditional Anatomic Stage (TNM), 100 patients were assigned to stage IA (T1N0) and 27 patients to stage IIA (T2N0). Applying the Prognostic stage (without RS) 89 patients were assigned to stage IA, 33 to stage IB, four to stage IIA, and one to stage IIB. All patients were assigned to stage IA according to the Prognostic stage that includes a RS of &amp;lt; 11. Comparing Prognostic stage without RS to traditional Anatomic stage, 26.7% of patients (n=34) underwent a change in stage, 9.4% (n=12) to a higher stage and 17.3% (n=22) to a lower stage. 21.3% (n=27) of patients were down staged when comparing Prognostic stage including RS to traditional Anatomic stage. Comparing Prognostic stage including RS to Prognostic stage without RS, 29.9% (n=38) of patients were down staged. CONCLUSION Breast cancer staging is an important tool in guiding patient management. This study demonstrates that the introduction of the Prognostic stage and the modified Prognostic stage to include RS will alter the assigned stage in approximately 25% of patients with early BC. REFERENCE Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, Gershenwald JE et al (2016). AJCC Cancer Staging Manual, 8th edn. Springer, Chicago. Citation Format: O'Cearbhaill RM, Gannon JM, Devane LA, Prichard RS, Walshe J, McDermott EW, Quinn CM. AJCC prognostic stage including oncotype DX®RS: Impact on breast cancer staging compared with traditional anatomic TNM stage [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-03-05.