Development and Validation of a Modified Eighth AJCC Staging System for Primary Pancreatic Neuroendocrine Tumors

156 Background: Adopting a unified staging system for pancreatic neuroendocrine tumors (PNET) has been challenging. Currently, the American Joint Committee on Cancer (AJCC) recommends the use of the pancreatic adenocarcinoma staging system for PNET. We sought to validate this recommendation on a large administrative population database. Methods: Surveillance, Epidemiology, and End Results (SEER) data were used to identify patients with PNET (excluding patients with large cell, small cell, or mixed endocrine-exocrine carcinoma) who underwent curative-intent surgical resection from 1983 to 2008. The discriminatory ability of the AJCC system (recorded by SEER since 2004) was examined and a new TNM system was devised utilizing extent of disease variables. Results: Of 1,202 patients identified, 51% were female. Median age was 55 years (range, 9-93). Lymph node metastasis (present in 43% of patients) was associated with worse overall survival (OS) after resection (10-year OS, 50% vs 63%, p<.0001), as was the presence of distant metastasis (present in 24% of patients, 10-year OS, 35% vs 63%, p<.0001).The current AJCC system (available in 412 patients) distinguished overall survival adequately only between stages I and II, but not between II and III, or III and IV (Table). By modifying the T stage to be based only on size (0-1 cm, 1-2 cm, 2-4 cm, and > 4 cm) and by revising the grouping allocation, we propose a novel TNM system with improved discriminatory ability (Table). Conclusions: In this study validating the current AJCC staging system for PNET, we found stages II, III, and IV to perform similarly. We propose a simplified TNM system that better discriminates between outcomes. [Table: see text]

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Prognostic validity of AJCC staging system in neuroendocrine tumors of the appendix

Annals of Oncology ◽

10.1093/annonc/mdw369.17 ◽

2016 ◽

Vol 27 ◽

pp. vi141 ◽

Cited By ~ 1

Author(s):

A. Mehrvarz Sarshekeh ◽

S. Advani ◽

M.R. Patel ◽

A. Dasari

Keyword(s):

Neuroendocrine Tumors ◽

Staging System ◽

Ajcc Staging System ◽

Ajcc Staging

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Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems

Journal of Clinical Oncology ◽

10.1200/jco.2016.67.8193 ◽

2017 ◽

Vol 35 (3) ◽

pp. 274-280 ◽

Cited By ~ 57

Author(s):

Guopei Luo ◽

Ammar Javed ◽

Jonathan R. Strosberg ◽

Kaizhou Jin ◽

Yu Zhang ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Neuroendocrine Tumors ◽

Statistical Significance ◽

Staging System ◽

Hazard Ratio ◽

Stage Iii ◽

Pancreatic Neuroendocrine Tumors ◽

American Joint Committee ◽

Ajcc Staging ◽

Staging Classification

Purpose The European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC) staging classifications are two widely used systems in managing pancreatic neuroendocrine tumors. However, there is no universally accepted system. Methods An analysis was performed to evaluate the application of the ENETS and AJCC staging classifications using the SEER registry (N = 2,529 patients) and a multicentric series (N = 1,143 patients). A modified system was proposed based on analysis of the two existing classifications. The modified system was then validated. Results The proportion of patients with AJCC stage III disease was extremely low for both the SEER series (2.2%) and the multicentric series (2.1%). For the ENETS staging system, patients with stage I disease had a similar prognosis to patients with stage IIA disease, and patients with stage IIIB disease had a lower hazard ratio for death than did patients with stage IIIA disease. We modified the ENETS staging classification by maintaining the ENETS T, N, and M definitions and adopting the AJCC staging definitions. The proportion of patients with stage III disease using the modified ENETS (mENETS) system was higher than that of the AJCC system in both the SEER series (8.9% v 2.2%) and the multicentric series (11.6% v 2.1%). In addition, the hazard ratio of death for patients with stage III disease was higher than that for patients with stage IIB disease. Moreover, statistical significance and proportional distribution were observed in the mENETS staging classification. Conclusion An mENETS staging classification is more suitable for pancreatic neuroendocrine tumors than either the AJCC or ENETS systems and can be adopted in clinical practice.

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Revisiting the AJCC staging system of adrenocortical carcinoma

Journal of Endocrinological Investigation ◽

10.1007/s40618-021-01618-0 ◽

2021 ◽

Author(s):

O. Abdel-Rahman

Keyword(s):

Adrenocortical Carcinoma ◽

Staging System ◽

Ajcc Staging System ◽

Ajcc Staging

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A Single-Institution Validation of the AJCC Staging System for Stage IV Melanoma

Annals of Surgical Oncology ◽

10.1245/s10434-008-9915-0 ◽

2008 ◽

Vol 15 (7) ◽

pp. 2034-2041 ◽

Cited By ~ 32

Author(s):

Heather B. Neuman ◽

Ami Patel ◽

Nicole Ishill ◽

Christine Hanlon ◽

Mary Sue Brady ◽

...

Keyword(s):

Stage Iv ◽

Staging System ◽

Single Institution ◽

Ajcc Staging System ◽

Ajcc Staging ◽

Stage Iv Melanoma

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Prognostic value of subclassification (pT2 stage) of pathologically organ-confined prostate cancer: Confirmation of the changes introduced in the 8th edition of the American Joint Committee on Cancer (AJCC) staging system

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.3.191 ◽

2018 ◽

Vol 90 (3) ◽

pp. 191-194 ◽

Cited By ~ 2

Author(s):

Hugo Pontes Antunes ◽

Belmiro Parada ◽

João Carvalho ◽

Miguel Eliseu ◽

Roberto Jarimba ◽

...

Keyword(s):

Prostate Cancer ◽

Specific Antigen ◽

Staging System ◽

Distant Metastases ◽

Grade Group ◽

Pathological Evaluation ◽

Ajcc Staging System ◽

Oncological Results ◽

Ajcc Staging ◽

8Th Edition

Objective: The last edition of the AJCC staging system eliminated the pT2 subclassification of prostate cancer (PCa). Our objective was to evaluate the association of pT2 subclassification with the oncological results of patients with PCa who underwent radical prostatectomy (RP). Material and methods: We evaluated 367 patients who underwent RP between 2009 and 2016, with pT2 disease in the final pathological evaluation. We assessed differences in rates of biochemical recurrence (BCR), metastasis and mortality between T2 substages (pT2a/b vs pT2c). Results: Fifty-three (14.4%) patients presented pT2a/b disease and 314 (85.6%) pT2c disease. The mean follow-up time was 4.9 ± 2.6 years. Grade group scores (p = 0.1) and prostate specific antigen (PSA) (p = 0.2) did not differed between pT2 substages. The rate of BCR in pT2a/b and pT2c patients was 11.3% and 18.2%, respectively (p = 0.2). Five (9.4%) patients with pT2a/b and 45 (14.3%) with pT2c substage underwent salvage radiotherapy (p = 0.3). The rate of positive surgical margins did not differ between groups (p = 0.2). Seven (2.2%) patients with pT2c had lymph nodes or distant metastases. The overall survival was 92.5% and 93.6% in pT2a/b and pT2c, respectively (p = 0.2). Conclusion: Our results are in accordance with the changes introduced in the 8th edition of the AJCC staging system in which the pT2 subclassification was eliminated.

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Concomitant Chemoradiation in Locally Advanced Laryngeal Cancer

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1030 ◽

2010 ◽

Vol 1 (3) ◽

pp. 153-160

Author(s):

Arif Jamshed ◽

Raza Hussain ◽

Sarah Jamshed ◽

Aamir Ali Syed ◽

Asif Loya ◽

...

Keyword(s):

Laryngeal Cancer ◽

Univariate Analysis ◽

Locally Advanced ◽

Survival Rates ◽

Staging System ◽

Nodal Disease ◽

Free Survival ◽

Concomitant Chemoradiation ◽

Ajcc Staging System ◽

Ajcc Staging

Abstract Introduction Despite the acceptance of concomitant chemoradiation (CRT) as an alternative to total laryngectomy (TL) in locally advanced laryngeal cancer (LALC), laryngeal preservation is sparingly recommended in developing countries. We report on prognostic factors and survival in T3/T4 laryngeal cancer treated with concomitant CRT at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH and RC) to provide comparison with other geographic locations. Material and Methods During the period November 2003-April 2009, 101 patients with biopsy proven untreated LALC underwent concurrent CRT treatment at SKMCH and RC. According to AJCC staging system (6th edition) 41 had T3 and 60 patients had T4 disease. Radiation dose to the larynx was 70 Gy in 35 fractions with concomitant cisplatin. Induction chemotherapy was given to 42 patients. Thirty-one patients required tracheotomy either before or during concomitant CRT. Results Actuarial overall survival and laryngectomy free survival (LFS) for the whole group at 5 years were 54% (95% CI; 48-60) and 47% (95% CI; 42-52) respectively. Median LFS was 4.17 years. On univariate analysis patients with T4 tumors (p = 0.04), positive neck nodal disease (p = 0.02), supraglottic site (p = 0.02) and tracheotomy (0.009) had a significantly inferior LFS. Multivariate analysis showed tracheotomy to be the only factor significantly (p = 0.03) related to a higher risk of failure for LFS. Conclusion Survival rates for LALC treated with concomitant CRT in our institution are acceptable. Our study supports the use of TL in patients with compromised airways that require tracheotomy as outcome with concomitant CRT is poor.

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