scholarly journals Melanoma Prognosis: Accuracy of the American Joint Committee on Cancer Staging Manual Eighth Edition

2020 ◽  
Vol 112 (9) ◽  
pp. 921-928 ◽  
Author(s):  
Shirin Bajaj ◽  
Douglas Donnelly ◽  
Melissa Call ◽  
Paul Johannet ◽  
Una Moran ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Statistical Tests ◽  
Area Under The Curve ◽  
Cancer Staging ◽  
Stage I ◽  
Stage Iii ◽  
Prognostic Accuracy ◽  
American Joint Committee ◽  
Melanoma Prognosis ◽  
Eighth Edition

Abstract Background The American Joint Committee on Cancer (AJCC) maintains that the eighth edition of its Staging Manual (AJCC8) has improved accuracy compared with the seventh (AJCC7). However, there are concerns that implementation may disrupt analysis of active clinical trials for stage III patients. We used an independent cohort of melanoma patients to test the extent to which AJCC8 has improved prognostic accuracy compared with AJCC7. Methods We analyzed a cohort of 1315 prospectively enrolled patients. We assessed primary tumor and nodal classification of stage I–III patients using AJCC7 and AJCC8 to assign disease stages at diagnosis. We compared recurrence-free (RFS) and overall survival (OS) using Kaplan-Meier curves and log-rank tests. We then compared concordance indices of discriminatory prognostic ability and area under the curve of 5-year survival to predict RFS and OS. All statistical tests were two-sided. Results Stage IIC patients continued to have worse outcomes than stage IIIA patients, with a 5-year RFS of 26.5% (95% confidence interval [CI] = 12.8% to 55.1%) vs 56.0% (95% CI = 37.0% to 84.7%) by AJCC8 (P = .002). For stage I, removing mitotic index as a T classification factor decreased its prognostic value, although not statistically significantly (RFS concordance index [C-index] = 0.63, 95% CI = 0.56 to 0.69; to 0.56, 95% CI = 0.49 to 0.63, P = .07; OS C-index = 0.48, 95% CI = 0.38 to 0.58; to 0.48, 95% CI = 0.41 to 0.56, P = .90). For stage II, prognostication remained constant (RFS C-index = 0.65, 95% CI = 0.57 to 0.72; OS C-index = 0.61, 95% CI = 0.50 to 0.72), and for stage III, AJCC8 yielded statistically significantly enhanced prognostication for RFS (C-index = 0.65, 95% CI = 0.60 to 0.70; to 0.70, 95% CI = 0.66 to 0.75, P = .01). Conclusions Compared with AJCC7, we demonstrate that AJCC8 enables more accurate prognosis for patients with stage III melanoma. Restaging a large cohort of patients can enhance the analysis of active clinical trials.

scholarly journals International Study of Primary Mucinous Ovarian Carcinomas Managed at Tertiary Medical Centers

2018 ◽  
Vol 28 (5) ◽  
pp. 915-924 ◽  
Author(s):  
Jennifer J. Mueller ◽  
Henrik Lajer ◽  
Berit Jul Mosgaard ◽  
Slim Bach Hamba ◽  
Philippe Morice ◽  
...  
Keyword(s):  
Early Stage ◽  
Statistical Tests ◽  
Stage Iv ◽  
Stage I ◽  
Stage Iii ◽  
Oncologic Outcomes ◽  
Disease Stage ◽  
Ovarian Carcinomas ◽  
Early Stage Disease ◽  
Medical Centers

ObjectiveWe sought to describe a large, international cohort of patients diagnosed with primary mucinous ovarian carcinoma (PMOC) across 3 tertiary medical centers to evaluate differences in patient characteristics, surgical/adjuvant treatment strategies, and oncologic outcomes.MethodsThis was a retrospective review spanning 1976–2014. All tumors were centrally reviewed by an expert gynecologic pathologist. Each center used a combination of clinical and histologic criteria to confirm a PMOC diagnosis. Data were abstracted from medical records, and a deidentified dataset was compiled and processed at a single institution. Appropriate statistical tests were performed.ResultsTwo hundred twenty-two patients with PMOC were identified; all had undergone primary surgery. Disease stage distribution was as follows: stage I, 163 patients (74%); stage II, 8 (4%); stage III, 40 (18%); and stage IV, 10 (5%). Ninety-nine (45%) of 219 patients underwent lymphadenectomy; 41 (19%) of 215 underwent fertility-preserving surgery. Of the 145 patients (65%) with available treatment data, 68 (47%) had received chemotherapy—55 (81%) a gynecologic regimen and 13 (19%) a gastrointestinal regimen. The 5-year progression-free survival (PFS) rates were 80% (95% confidence interval [CI], 73%–85%) for patients with stage I to II disease and 17% (95% CI, 8%–29%) for those with stage III to IV disease. The 5-year PFS rate was 73% (95% CI, 50%–86%) for patients who underwent fertility-preserving surgery.ConclusionsMost patients (74%) presented with stage I disease. Nearly 50% were treated with adjuvant chemotherapy using various regimens across institutions. The PFS outcomes were favorable for those with early-stage disease and lower but acceptable for those who underwent fertility preservation.

scholarly journals Survival of patients with early invasive melanoma down-staged under the new eighth edition of the American Joint Committee on Cancer staging system

2019 ◽  
Vol 80 (1) ◽  
pp. 272-274 ◽  
Author(s):  
Lena A. von Schuckmann ◽  
Maria Celia B. Hughes ◽  
Rebecca Lee ◽  
Paul Lorigan ◽  
Kiarash Khosrotehrani ◽  
...  
Keyword(s):  
Staging System ◽  
Cancer Staging ◽  
American Joint Committee ◽  
Eighth Edition

Validation of the Novel Eighth Edition of American Joint Committee on Cancer Staging Manual

Pancreas ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. e42-e43
Author(s):  
Min Yang ◽  
Lin Zeng ◽  
Neng-wen Ke ◽  
Chun-lu Tan ◽  
Bo-le Tian ◽  
...  
Keyword(s):  
Cancer Staging ◽  
The Novel ◽  
American Joint Committee ◽  
Eighth Edition

scholarly journals Application of Thromboelastography to Predict Lung Cancer Stage

2020 ◽  
Vol 19 ◽  
pp. 153303382095235
Author(s):  
Yaning Zhou ◽  
Yijun Guo ◽  
Qing Cui ◽  
Yun Dong ◽  
Xiaoyue Cai ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Tnm Classification ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Maximum Amplitude ◽  
Stage Iv ◽  
Tnm Stage ◽  
Stage I ◽  
Stage Iii ◽  
Α Angle

Objective: Lung cancer is often associated with hypercoagulability. Thromboelastography provides integrated information on clot formation in whole blood. This study explored the possible relationship between thromboelastography and lung cancer. Methods: Lung cancer was staged according to the Tumor, Node, and Metastasis (TNM) classification system. Thromboelastography parameters in different stages of disease were compared. The value of thromboelastography for stage prediction was determined by area under the receiver operating characteristic curve analysis. Results: A total of 182 patients diagnosed with lung cancer were included. Thromboelastography parameters, including kinetics time, α-angle, and maximum amplitude, differed significantly between patients with metastatic and limited lung cancers ( P < 0.05). Kinetics time was significantly reduced and maximum amplitude was significantly increased in patients with stage I and II compared with stage III and IV tumors ( P < 0.05). TNM stage was significantly negatively correlated with kinetics time ( r = −0.186), and significantly positively correlated with α-angle ( r = 0.151) and maximum amplitude ( r = 0.251) (both P < 0.05). The area under the curve for kinetics time in patients with stage I cancer was 0.637 ( P < 0.05) and that for α-angle in stage ≥ II was 0.623 ( P < 0.05). The areas under the curves for maximum amplitude in stage ≥ III and stage IV cancer were 0.650 and 0.605, respectively (both P < 0.05). Thromboelastography parameters were more closely associated with TNM stage in patients with lung adenocarcinoma than in the whole lung cancer population. Conclusion: This study identified the diagnostic value of thromboelastography parameters for determining tumor stage in patients with lung cancer. Thromboelastography can be used as an independent predictive parameter for lung cancer severity.

scholarly journals Multicenter, International Assessment of the Eighth Edition of the American Joint Committee on Cancer Cancer Staging Manual for Conjunctival Melanoma

2019 ◽  
Vol 137 (8) ◽  
pp. 905 ◽  
Author(s):  
Puneet Jain ◽  
Paul T. Finger ◽  
Bertil Damato ◽  
Sarah E. Coupland ◽  
Heinrich Heimann ◽  
...  
Keyword(s):  
Cancer Staging ◽  
Conjunctival Melanoma ◽  
American Joint Committee ◽  
International Assessment ◽  
Eighth Edition

scholarly journals Prognostic Validity of the American Joint Committee on Cancer Eighth Edition Staging System for Well-Differentiated Pancreatic Neuroendocrine Tumors: A Retrospective Multinational Multicenter Study

2020 ◽  
Author(s):  
Hebin Wang ◽  
Ding Ding ◽  
Tingting Qin ◽  
Jun Liu ◽  
Hang Zhang ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Staging System ◽  
Tnm Staging ◽  
Stage I ◽  
Pancreatic Neuroendocrine Tumors ◽  
American Joint Committee ◽  
Staging Systems ◽  
Significant Difference ◽  
Well Differentiated ◽  
Eighth Edition

Abstract Background:There is no widely-accepted staging system for pancreatic neuroendocrine tumors (pNETs). The aim of this study was to validate the American Joint Committee on Cancer (AJCC) 8th edition staging system for well-differentiated (G1/G2) pNETs.Methods:A multicenter dataset (n=1086) was used to evaluate the application of the AJCC 7th and 8th, the European Neuroendocrine Tumor Society (ENETS), and the modified ENETS (mENETS) staging systems for well-differentiated pNETs.Results:The proportion of patients with stage III tumors was extremely low (1.1%) according to the AJCC 7th staging system. For the ENETS staging system, patients with stage IIIA disease had worse estimated mean survival than patients with stage IIIB disease (78.9 vs. 107.3 months). When comparing with patients in stage I, the AJCC 7th, ENETS, and mENETS staging systems showed good performance in discriminating between stages; however, there was no significant difference in some stages when the reference was defined as the earlier stage. When the reference was defined as stage I or the earlier stage, there was a significant inter-stage difference in the AJCC 8th staging system.Conclusions:The AJCC 8th staging system is more suitable for pNETs than other TNM staging systems and may be adopted in clinical practice.

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