AJCC Cancer Staging Manual 7th Edition Criteria for Colon Cancer: Do the Complex Modifications Improve Prognostic Assessment?
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Intrahepatic cholangiocarcinoma (ICC) was differentiated from hepatocellular carcinoma, as defined in the American Joint Committee on Cancer (AJCC) 6th edition staging manual, using the revised staging system described in the AJCC 7th edition staging manual. This study was conducted to analyze the application of the AJCC 6th and 7th edition staging classifications and to evaluate a modified staging classification to potentially reduce the limitations associated with the different AJCC staging systems.We compared the prognostic value of cancer staging using data from the Surveillance, Epidemiology, and End Results database (N = 2124). The Kaplan-Meier method and Cox regression models were used to analyze survival. The Harrell concordance index (C-index) was used to analyze the discriminative abilities of cancer staging.Patients with stages I and II disease were found to have similar prognoses according to the 6th edition staging system. Using the 7th edition staging system, a low proportion of patients had stage III disease (5.0%), and the hazard ratio (HR) for stage III disease was comparable to that of stage IV disease (stage III and IV, 2.653 and 2.694). We modified the AJCC staging classification by adopting the 7th edition T, N, and M definitions and the 6th edition staging definitions. Consequently, the proportion of patients with stage III disease increased (22.8%). The HR for stage IV disease was higher than that for stage III disease (stage III and IV, 2.425 and 2.956). Meanwhile, the C-index of the modified AJCC staging system was 0.721 (95% CI: 0.696-0.745), which was significantly higher than the AJCC 7th edition staging system (0.694, P < .001), and the AJCC 6th edition staging system (0.712, P = .033). Moreover, in the stratified data, the differences between the stages identified using the modified AJCC staging classification were significant, especially among patients over 60 years in age, white patients and patients who underwent surgery.These findings suggest that the modified AJCC staging classification may be applicable to the staging of ICC and can be adopted in clinical practice.
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The 7th edition American Joint Committee on Cancer tumor-node-metastasis (AJCC TNM) staging system was published in 2010. Here we evaluate its predictive ability and compare the 6th and 7th editions of the AJCC TNM staging systems in esophageal squamous cell cancer (ESCC) with preoperative radiotherapy.A total of 296 esophageal squamous cell carcinoma patients receiving preoperative radiotherapy between 1980 and 2007 were included. Patients were staged using the 6th and 7th edition staging systems. Survival analyses were performed using Cox regression models. The homogeneity, discriminatory ability, and monotonicity of gradients of the two staging systems were compared using linear trend χ(2), likelihood ratio statistics, and Akaike information criterion calculation.The overall five-year survival rate for the entire cohort was 27.1%. Female gender, length, "T," and "N," classifications according to the 7th edition staging system were the prognostic factors in univariate analyses. However, tumor histological grade and cancer location did not significantly influence patient survival. The 7th edition staging system has the highest linear trend χ(2)and likelihood ratio χ(2)scores. Compared to the 6th edition, the 7th edition staging system also has a smaller Akaike information criterion value, which represents the optimum prognostic stratification.The strength of the 7th edition AJCC TNM staging system lies in the new descriptors for "T" and "N" classifications. However, we did not find cancer location to be a significant prognostic factor in our cohort. Overall, the 7th edition AJCC TNM staging system performed better than the previous edition.
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BACKGROUND The fifth edition of the American Joint Committee on Cancer staging manual defines new rules for classifying nasopharyngeal carcinoma. The authors tested the value of this new system by applying these rules retrospectively to their previously treated patients and comparing the results with those obtained using the fourth edition of the AJCC staging manual or the Ho staging system. METHODS Information from 107 patients who had biopsy-proven squamous cell carcinoma of the nasopharynx that was treated in a constant fashion with definitive-intent radiation therapy alone at one institution provided the data base for this analysis. The extent of disease of each patient was staged according to the rules of 1) the fourth edition of the AJCC staging manual, 2) the Ho staging system, and 3) the fifth edition of the AJCC staging manual. RESULTS The new system appears to be better than the two previous systems. It separated patients into cohorts of more equal size than did either of the other systems. It also correlated with outcome for the study population more appropriately than did the fourth edition of the AJCC staging manual or the Ho staging system. CONCLUSIONS The fifth edition of the AJCC staging manual appears to be an improvement over the previous AJCC or Ho staging systems for the staging of nasopharyngeal carcinoma. Cancer 1998;83:213-219. © 1998 American Cancer Society.
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BACKGROUND The fifth edition of the American Joint Committee on Cancer staging manual defines new rules for classifying nasopharyngeal carcinoma. The authors tested the value of this new system by applying these rules retrospectively to their previously treated patients and comparing the results with those obtained using the fourth edition of the AJCC staging manual or the Ho staging system. METHODS Information from 107 patients who had biopsy-proven squamous cell carcinoma of the nasopharynx that was treated in a constant fashion with definitive-intent radiation therapy alone at one institution provided the data base for this analysis. The extent of disease of each patient was staged according to the rules of 1) the fourth edition of the AJCC staging manual, 2) the Ho staging system, and 3) the fifth edition of the AJCC staging manual. RESULTS The new system appears to be better than the two previous systems. It separated patients into cohorts of more equal size than did either of the other systems. It also correlated with outcome for the study population more appropriately than did the fourth edition of the AJCC staging manual or the Ho staging system. CONCLUSIONS The fifth edition of the AJCC staging manual appears to be an improvement over the previous AJCC or Ho staging systems for the staging of nasopharyngeal carcinoma. Cancer 1998;83:213-219. © 1998 American Cancer Society.
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