scholarly journals Updates in the 8th edition of the TNM staging system for esophagus and esophagogastric junction cancer

2020 ◽  
Vol 50 (8) ◽  
pp. 847-851 ◽  
Author(s):  
Hiroyuki Daiko ◽  
Ken Kato
Keyword(s):  
Esophagogastric Junction ◽  
Tnm Classification ◽  
Cancer Control ◽  
Main Tool ◽  
Staging System ◽  
Tumor Location ◽  
Tnm Staging ◽  
7Th Edition ◽  
Definition Of ◽  
8Th Edition

Abstract The tumor–node metastasis (TNM) classification, originally developed in 1943 and subsequently adopted by the Union for International Cancer Control and the American Joint Committee on Cancer, is regularly updated based on new information and developments. The TNM classification system is the main tool used for both clinical and pathological staging of cancers worldwide. The 8th edition of the TNM classification for esophageal and esophagogastric junction (EGJ) cancer, released in 2017, was updated from the 7th edition based on additional data supplied by the Worldwide Esophageal Cancer Collaboration group. We summarize the main changes between the 7th and 8th editions of this TNM classification. Notable changes included separate clinical, pathological and pathological prognostic staging for adenocarcinomas and squamous cell carcinomas. Pathological prognostic staging was also improved by updating the T- and N-factors regarding histopathological differentiation and tumor location, respectively. The definition of EGJ cancer was changed from tumors centered within 5 cm to tumors within 2 cm of the EGJ. These updates to the TNM classification will help to improve the personalized management and treatment of patients with esophageal and EGJ cancers.

RA09.08: EVALUATION OF THE EIGHTH YPTNM CLASSIFICATION SYSTEM IN ESOPHAGEAL CANCER PATIENTS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 41-42
Author(s):  
Motoo Nomura ◽  
Shigeru Tsunoda ◽  
Katsuyuki Sakanaka ◽  
Masashi Tamaoki ◽  
Yusuke Amanuma ◽  
...  
Keyword(s):  
Staging System ◽  
Tnm Staging ◽  
Prognostic Impact ◽  
Poor Prognostic Factor ◽  
Pathologic Stage ◽  
7Th Edition ◽  
Tnm Staging System ◽  
Staging Systems ◽  
Prognostic Group ◽  
8Th Edition

Abstract Background The 7th edition of the Union for International Cancer Control (UICC) TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. In the 8th edition of UICC-TNM staging system, there is no information available for treatment modality (surgery alone or neoadjuvant therapy [NAC] followed by surgery [NAC-S]), although clinical stage, neoadjuvant pathologic stage, and pathologic stage were analyzed and identified. The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal squamous cell cancer (ESCC) patients treated by NAC-S. Methods Database of 140 consecutive ESCC patients in our hospital was retrospectively restaged in 7th and 8th UICC-TNM system. The prognostic impacts of pathologic stage after NAC according to the both staging systems were compared. Results The median follow-up period was 4.8 years (range 0.2–9.7), with 49 patients dead at the time of analysis. In 7th edition, the 3-year overall survival rates (3y-OS) of ypStages 0, I, II, III, and IV were 100%, 93.5%, 93.5%, 43.9%, and 0.0%, respectively. In 8th edition, the 3y-OS of ypStages 0, I, II, III, and IV were 100%, 96.5%, 90.2%, 51.7%, and 29.6%, respectively. There were no marked differences between 7th and 8th edition in the prognoses. The both editions poorly distinguish the prognoses of ypStages 0, I, and II. For pathological prognostic group in 7th edition, the 3y-OS of Groups 0, I, II, III, and IV were 100%, 97.0%, 90.6%, 43.9%, and 0.0%, respectively. For pathological prognostic group in 8th edition, the 3y-OS of Groups 0, I, II, III, and IV were 100%, 96.7%, 89.8%, 51.7%, and 29.6%, respectively. For patients with ypStages 0-II, pretreatment higher CEA was poor prognostic factor (HR 7.1, 95% confidence interval 1.9–25.9). Conclusion Our study indicates the problem that the ypStage in the 8th TNM staging system poorly distinguish the prognoses of ypStages 0, I, and II in patients undergoing NAC-S. Additional study is needed to evaluate the role of ypStage 0-II incorporation of new prognostic factors. Disclosure All authors have declared no conflicts of interest.

Different View on Tumor Size Dilemma in Tumor-Node-Metastasis Staging System for Thymoma

2020 ◽  
Author(s):  
Ayten Kayı Cangir ◽  
Bülent Mustafa Yenigün ◽  
Tamer Direk ◽  
Gokhan Kocaman ◽  
Ugurum Yücemen ◽  
...  
Keyword(s):  
Tumor Size ◽  
Tnm Classification ◽  
Staging System ◽  
Tnm Staging ◽  
R0 Resection ◽  
Tumor Diameter ◽  
Tumor Node Metastasis ◽  
Node Metastasis ◽  
The Mean ◽  
Definition Of

Abstract Background Although tumor size is included in the definition of T descriptor in the tumor-node-metastasis (TNM) classification of many solid tumors, it is not considered for thymomas. This study aimed to assess the relationship of tumor diameters (the largest tumor diameter [LTD] and the mean tumor diameter [MTD]) with survival in thymoma patients undergoing surgical resection in a single center. Methods The study included 127 thymoma patients (age, 49.2 ± 15.2 years; 65 males), who were evaluated based on pathological tumor sizes according to the LTD and MTD ([largest diameter + shortest diameter] / 2) and divided into three subgroups for each parameter as: patients with an LTD of ≤5 cm, 5.1 to 10 cm, and >10 cm and patients with an MTD of ≤5, 5.1 to 10, and >10 cm. Results In thymoma patients, survival significantly differed according to the presence of myasthenia gravis (p = 0.018), resection status (R0 or R1; p = 0.001), T status (p = 0.015), and the Masaoka–Koga stage (p = 0.003). In the LTD subgroups, the overall survival of those with R0 resection was lower in those with an LTD of 5.1 to 10 cm than in those with an LTD of ≤5 cm (p = 0.051) and significantly lower in those with an MTD of 5.1 to 10 cm than in those with an MTD of ≤5 cm (p = 0.027). In the MTD subgroups, survival decreased as the tumor size increased. Conclusion Both smaller tumor size and complete resection are associated with better survival in thymoma patients. Therefore, the largest or the mean tumor size might be considered as a criterion in the TNM staging for thymoma.

Disease-Free Survival for Patients with Thin Melanomas according to the American Joint Committee on Cancer 8th Edition

Dermatology ◽  
2019 ◽  
Vol 235 (4) ◽  
pp. 334-339
Author(s):  
◽  
Luisa Elena Gambra Michel ◽  
Jon Uña Gorospe ◽  
Antonio Luis López Figueroa ◽  
Raquel Mullor Nogales ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Staging System ◽  
Tnm Staging ◽  
Wilcoxon Test ◽  
Rank Test ◽  
Free Survival ◽  
7Th Edition ◽  
Kaplan Meier ◽  
Disease Free ◽  
8Th Edition

Background: The recently implemented AJCC 8th edition TNM staging system for malignant melanoma (MM) changed the definition for T1a and T1b tumours. Objectives: To analyse differences in disease-free survival (DFS) among patients with thin MM staged according to both AJCC 7th and 8th editions. Methods: An observational study including 285 patients with cutaneous thin MM (thickness ≤1 mm). Cases were staged as T1a and T1b using both 7th and 8th editions. Neither regional nor visceral diseases were present at diagnosis. DFS curves were generated according to the Kaplan-Meier method. Results: An 8% shift of patients from a T1a towards a T1b stage group was observed after applying the AJCC 8th edition. According to this 8th edition, DFS for T1a patients was significantly longer than for T1b patients (log-rank test; p = 0.005); 5-year DFS for T1a and T1b was 100 and 95%, respectively (Wilcoxon test; p = 0.002). According to the AJCC 7th edition, DFS did not significantly differ for T1a and T1b patients; 5-year DFS for T1a and T1b was 99 and 97%, respectively (p > 0.05). Conclusions: The AJCC 8th edition seems to be a better tool for staging thin melanomas.

Prognostic Accuracy of the Eighth Edition of TNM Classification Compared with the Seventh and Sixth Edition for Perihilar Cholangiocarcinoma

2020 ◽  
Author(s):  
Hans Michael Hau ◽  
Felix Meyer ◽  
Sebastian Rademacher ◽  
Robert Sucher ◽  
Daniel Seehofer
Keyword(s):  
Liver Resection ◽  
Tnm Classification ◽  
Staging System ◽  
Perihilar Cholangiocarcinoma ◽  
7Th Edition ◽  
Prognostic Accuracy ◽  
Staging Systems ◽  
Ajcc Staging System ◽  
Ajcc Staging ◽  
8Th Edition

Abstract Background This study was conducted to evaluate and compare the prognostic value and performance of the 6th, 7th, and 8th editions of the American Joint Committee on Cancer (AJCC) staging system when applied to patients undergoing surgery for perihilar cholangiocarcinoma (PHC). Methods Patients undergoing liver resection with curative intention for PHC between 2002 and 2019 were identified from a prospective database. Histopathological parameters and stage of the PHC were assessed according to the 6th, 7th, and 8th editions of the tumor node metastasis (TNM) classification. The prognostic accuracy between staging systems was compared using the area under the receiver operating characteristic curve (AUC) model. Results Data for a total of 95 patients undergoing liver resection for PHC were analyzed. The median overall survival time was 21 months (95% CI 8.1–33.9), and the 3- and 5-year survival rates were 46.1% and 36.2%, respectively. Staging according to the 8th edition versus the 7th edition resulted in reclassification of 25 patients (26.3%). The log-rank p-values for the 7th and 8th edition were highly statistically significant (p ≤ 0.01) compared to the 6th edition (p = 0.035). The AJCC 8th edition staging system had a slightly better discrimination ability, with an AUC of 0.69 (95% CI: 0.52–0.84) compared to 0.61 (95% CI: 0.51–0.73) for the 7th edition. Multivariate survival analysis revealed male gender, age > 65 years, positive resection margins, presence of distant metastases, poorly tumor differentiation, lymph node involvement such as no caudate lobe resection as independent predictors of poor survival (p < 0.05). Conclusion The newly released 8th edition of the AJCC staging system demonstrated a poor to moderate ability to predict prognosis of patients undergoing liver resection for perihilar cholangiocarcinoma; the result was only slightly better than the previous 7th edition. Further refinements are needed to improve the prognostic ability of the AJCC staging system for perihilar cholangiocarcinoma and to identify other prognostic factors that can potentially improve individual patient prognostication.

Evaluation of the seventh TNM classification system in patients with esophageal cancer receiving chemoradiotherapy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 83-83
Author(s):  
M. Nomura ◽  
T. Kodaira ◽  
A. Mizota ◽  
C. Kondoh ◽  
K. Shitara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Classification System ◽  
Tnm Classification ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Cancer Site ◽  
Prognostic Impact ◽  
7Th Edition ◽  
Prognostic Group

83 Background: The new 7th edition of the TNM classification system is based on pathologic data of esophageal cancer underwent surgery alone. No report is available on the prognostic evaluation of the new staging system in patients treated with chemoradiotherapy (CRT). The objective of this study was to evaluate the prognostic impact of the 7th edition of the TNM staging system in esophageal cancer patients treated with CRT. Methods: A retrospective review was performed of 301 consecutive patients who met the following inclusion criteria: (1) squamous cell carcinoma of thoracic esophagus; (2) total radiation dose ≥ 50 Gy; (3) concomitant chemotherapy consisting of 5-fluolouracil and platinum; (4) no previous thoracic radiotherapy or surgery. We compared the prognostic impact of the 6th and 7th editions of the TNM staging systems. Also, we compared the prognostic impact of stage group and prognostic group, which was newly defined in the 7th edition. Survival analysis was performed by using log-rank and Cox regression testing. Results: Patients with stage I/II/III/IV were 52/42/54/153 and 57/46/128/70 according to 6th and 7th edition, respectively. Eighty-four patients were shifted to a lower stage in 7th edition compared with 6th edition, and most of these were from stage IV to III (n = 74). There were significant differences among stages I to III (p < 0.01, respectively) according to each edition. However, 7th edition poorly distinguishes between stages III and IV (p = 0.43). The survival curve of stage IV (lymph) almost completely overlapped with stage III (p = 0.69), although there were significant differences between stages IV (lymph) and IV (organ) (p = 0.04). Among the factors included in prognostic group in 7th edition, the histological grade and cancer site had no significant influence on patient survival, and T factor was only independent prognostic factors in multivariate analysis (p < 0.01). Conclusions: Our study suggested several pitfalls in 7th TNM classification as prognostic factor in patients who received CRT. No significant financial relationships to disclose.

scholarly journals Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma

2020 ◽  
Vol 9 (10) ◽  
pp. 3152
Author(s):  
Hans-Michael Hau ◽  
Felix Meyer ◽  
Nora Jahn ◽  
Sebastian Rademacher ◽  
Robert Sucher ◽  
...  
Keyword(s):  
Liver Resection ◽  
Prognostic Value ◽  
Tnm Classification ◽  
Staging System ◽  
Perihilar Cholangiocarcinoma ◽  
7Th Edition ◽  
Staging Systems ◽  
Ajcc Staging System ◽  
Ajcc Staging ◽  
8Th Edition

Objectives: In our study, we evaluated and compared the prognostic value and performance of the 6th, 7th, and 8th editions of the American Joint Committee on Cancer (AJCC) staging system in patients undergoing surgery for perihilar cholangiocarcinoma (PHC). Methods: Patients undergoing liver surgery with curative intention for PHC between 2002 and 2019 were identified from a prospective database. Histopathological parameters and stage of the PHC were assessed according to the 6th, 7th, and 8th editions of the tumor node metastasis (TNM) classification. The prognostic accuracy between staging systems was compared using the area under the receiver operating characteristic curve (AUC) model. Results: Data for a total of 95 patients undergoing liver resection for PHC were analyzed. The median overall survival time was 21 months (95% CI 8.1–33.9), and the three- and five-year survival rates were 46.1% and 36.2%, respectively. Staging according to the 8th edition vs. the 7th edition resulted in the reclassification of 25 patients (26.3%). The log-rank p-values for the 7th and 8th editions were highly statistically significant (p ≤ 0.01) compared to the 6th edition (p = 0.035). The AJCC 8th edition staging system showed a trend to better discrimination, with an AUC of 0.69 (95% CI: 0.52–0.84) compared to 0.61 (95% CI: 0.51–0.73) for the 7th edition. Multivariate survival analysis revealed male gender, age >65 years, positive resection margins, presence of distant metastases, poorly tumor differentiation, and lymph node involvement, such as no caudate lobe resection, as independent predictors of poor survival (p < 0.05). Conclusions: In the current study, the newly released 8th edition of AJCC staging system showed no significant benefit compared to the previous 7th edition in predicting the prognosis of patients undergoing liver resection for perihilar cholangiocarcinoma. Further research may help to improve the prognostic value of the AJCC staging system for PHC—for instance, by identifying new prognostic markers or staging criteria, which may improve that individual patient’s outcome.

scholarly journals Updates in Staging and Reporting of Genitourinary Malignancies

2020 ◽  
Vol 144 (3) ◽  
pp. 305-319 ◽  
Author(s):  
Kristine M. Cornejo ◽  
Travis Rice-Stitt ◽  
Chin-Lee Wu
Keyword(s):  
Tnm Classification ◽  
Staging System ◽  
Cancer Staging ◽  
Classification Systems ◽  
Tumor Node Metastasis ◽  
7Th Edition ◽  
Pathologic Staging ◽  
Ajcc Staging ◽  
8Th Edition ◽  
Made In

Context.— The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual changed the tumor, node, metastasis (TNM) classification systems of genitourinary malignancies in 2017. However, some of the changes appear not well appreciated or recognized by practicing pathologists. Objective.— To review the major changes compared with the 7th edition in cancers of the prostate, penis, testis, bladder, urethra, renal pelvis/ureter, and kidney and discuss the challenges that pathologists may encounter. Data Sources.— Peer-reviewed publications and the 8th and 7th editions of the AJCC Cancer Staging Manual. Conclusions.— This article summarizes the updated staging of genitourinary malignancies, specifically highlighting changes from the 7th edition that are relevant to the pathologic staging system. Pathologists should be aware of the updates made in hopes of providing clarification and the remaining diagnostic challenges associated with these changes.

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