The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM
TL;DR: A marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping are notable.
Abstract: The American Joint Committee on Cancer and the International Union for Cancer Control update the tumor-node-metastasis (TNM) cancer staging system periodically. The most recent revision is the 7th edition, effective for cancers diagnosed on or after January 1, 2010. This editorial summarizes the background of the current revision and outlines the major issues revised. Most notable are the marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping. The future of cancer staging lies in the use of enhanced registry data standards to support personalization of cancer care through cancer outcome prediction models and nomograms.
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TL;DR: Progress against CRC can be accelerated by increasing access to guideline‐recommended screening and high‐quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle‐aged adults.
Abstract: Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population-based cancer registries and mortality data (through 2017) from the National Center for Health Statistics. In 2020, approximately 147,950 individuals will be diagnosed with CRC and 53,200 will die from the disease, including 17,930 cases and 3,640 deaths in individuals aged younger than 50 years. The incidence rate during 2012 through 2016 ranged from 30 (per 100,000 persons) in Asian/Pacific Islanders to 45.7 in blacks and 89 in Alaska Natives. Rapid declines in incidence among screening-aged individuals during the 2000s continued during 2011 through 2016 in those aged 65 years and older (by 3.3% annually) but reversed in those aged 50 to 64 years, among whom rates increased by 1% annually. Among individuals aged younger than 50 years, the incidence rate increased by approximately 2% annually for tumors in the proximal and distal colon, as well as the rectum, driven by trends in non-Hispanic whites. CRC death rates during 2008 through 2017 declined by 3% annually in individuals aged 65 years and older and by 0.6% annually in individuals aged 50 to 64 years while increasing by 1.3% annually in those aged younger than 50 years. Mortality declines among individuals aged 50 years and older were steepest among blacks, who also had the only decreasing trend among those aged younger than 50 years, and excluded American Indians/Alaska Natives, among whom rates remained stable. Progress against CRC can be accelerated by increasing access to guideline-recommended screening and high-quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle-aged adults.
2,928 citations
TL;DR: A new classification of CC into six molecular subtypes that arise through distinct biological pathways that improves the current disease stratification based on clinicopathological variables and common DNA markers is described.
Abstract: Background
Colon cancer (CC) pathological staging fails to accurately predict recurrence, and to date, no gene expression signature has proven reliable for prognosis stratification in clinical practice, perhaps because CC is a heterogeneous disease. The aim of this study was to establish a comprehensive molecular classification of CC based on mRNA expression profile analyses.
1,065 citations
TL;DR: University College, London Cancer Institute, 72 Huntley St.
1,043 citations
Cites background or methods from "The American Joint Committee on Can..."
...’’ In fact, up until the current 7th edition of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICCA) staging manual, there was no distinct internationally recognized staging system for iCCA [137]....
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...With the recent publication of the 7th edition of the AJCC/UICCA staging manual, there is now a new distinct staging system for iCCA [137]....
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...Specifically, tumor size is no longer a prognostic factor, rather, T-classification is based on the number of lesions, vascular invasion, intrahepatic metastasis, and invasion of adjacent structures [137]....
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...The 7th edition AJCC/UICCA staging system largely reflects many of the proposals included in previous publications [137,142]....
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Sapienza University of Rome1, Marche Polytechnic University2, University of Copenhagen3, University of Milan4, Rikshospitalet–Radiumhospitalet5, University of Oslo6, University of Edinburgh7, University of Würzburg8, Greifswald University Hospital9, University of Zurich10, Medical University of Vienna11, University of Salamanca12
TL;DR: This Consensus Statement aims to provide valuable information on classifications, pathological features, risk factors, cells of origin, genetic and epigenetic modifications and current therapies available for this cancer.
Abstract: Cholangiocarcinoma (CCA) is a heterogeneous group of malignancies with features of biliary tract differentiation. CCA is the second most common primary liver tumour and the incidence is increasing worldwide. CCA has high mortality owing to its aggressiveness, late diagnosis and refractory nature. In May 2015, the "European Network for the Study of Cholangiocarcinoma" (ENS-CCA: www.enscca.org or www.cholangiocarcinoma.eu) was created to promote and boost international research collaboration on the study of CCA at basic, translational and clinical level. In this Consensus Statement, we aim to provide valuable information on classifications, pathological features, risk factors, cells of origin, genetic and epigenetic modifications and current therapies available for this cancer. Moreover, future directions on basic and clinical investigations and plans for the ENS-CCA are highlighted.
904 citations
Posted Content•
TL;DR: The power of using deep learning to produce significant improvements in the accuracy of pathological diagnoses is demonstrated, by combining the deep learning system's predictions with the human pathologist's diagnoses.
Abstract: The International Symposium on Biomedical Imaging (ISBI) held a grand challenge to evaluate computational systems for the automated detection of metastatic breast cancer in whole slide images of sentinel lymph node biopsies. Our team won both competitions in the grand challenge, obtaining an area under the receiver operating curve (AUC) of 0.925 for the task of whole slide image classification and a score of 0.7051 for the tumor localization task. A pathologist independently reviewed the same images, obtaining a whole slide image classification AUC of 0.966 and a tumor localization score of 0.733. Combining our deep learning system's predictions with the human pathologist's diagnoses increased the pathologist's AUC to 0.995, representing an approximately 85 percent reduction in human error rate. These results demonstrate the power of using deep learning to produce significant improvements in the accuracy of pathological diagnoses.
739 citations
Cites background from "The American Joint Committee on Can..."
...The evaluation of breast sentinel lymph nodes is an important component of the American Joint Committee on Cancer’s TNM breast cancer staging system, in which patients with a sentinel lymph node positive for metastatic cancer will receive a higher pathologic TNM stage than patients negative for sentinel lymph node metastasis [6], frequently resulting in more aggressive clinical management, including axillary lymph node dissection [13, 14]....
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Book•
17 Sep 2013
TL;DR: Purposes and Principles of Cancer Staging and End-Results Reporting are explained.
Abstract: General Information on Cancer Staging and End-Results Reporting.- Purposes and Principles of Cancer Staging.- Cancer Survival Analysis.- Head and Neck.- Lip and Oral Cavity.- Pharynx.- Larynx.- Nasal Cavity and Paranasal Sinuses.- Major Salivary Glands.- Thyroid.- Mucosal Melanoma of the Head and Neck.- Digestive System.- Esophagus and Esophagogastric Junction.- Stomach.- Small Intestine.- Colon and Rectum.- Anus.- Gastrointestinal Stromal Tumor.- Neuroendocrine Tumors.- Liver.- Intrahepatic Bile Ducts.- Gallbladder.- Perihilar Bile Ducts.- Distal Bile Duct.- Ampulla of Vater.- Exocrine and Endocrine Pancreas.- Thorax.- Lung.- Pleural Mesothelioma.- Musculoskeletal Sites.- Bone.- Soft Tissue Sarcoma.- Skin.- Cutaneous Squamous Cell Carcinoma and Other Cutaneous Carcinomas.- Merkel Cell Carcinoma.- Melanoma of the Skin.- Breast.- Breast.- Gynecologic Sites.- Vulva.- Vagina.- Cervix Uteri.- Corpus Uteri.- Ovary and Primary Peritoneal Carcinoma.- Fallopian Tube.- Gestational Trophoblastic Tumors.- Genitourinary Sites.- Penis.- Prostate.- Testis.- Kidney.- Renal Pelvis and Ureter.- Urinary Bladder.- Urethra.- Adrenal.- Ophthalmic Sites.- Carcinoma of the Eyelid.- Carcinoma of the Conjunctiva.- Malignant Melanoma of the Conjunctiva.- Malignant Melanoma of the Uvea.- Retinoblastoma.- Carcinoma of the Lacrimal Gland.- Sarcoma of the Orbit.- Ocular Adnexal Lymphoma.- Central Nervous System.- Brain and Spinal Cord.- Lymphoid Neoplasms.- Lymphoid Neoplasms.
16,806 citations
01 Jan 2010
937 citations
"The American Joint Committee on Can..." refers methods in this paper
...The latest revision of TNM, presented in the 7th edition of the AJCC Cancer Staging Manual, takes effect for cases diagnosed on or after January 1, 2010.(1) This supplants the 6th edition, in use since 2003....
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