Multiparameter Gene Expression Assays and Breast Cancer Management
Sherry X. Yang, Janet E. Dancey in Handbook of Therapeutic Biomarkers in Cancer, 2021
The 8th edition of the American Joint Committee on Cancer (AJCC) Staging System, which took effect January 2018, incorporated prognostic and predictive biomarkers into the staging classifications. Under AJCC 8, breast cancers are assigned both an anatomic stage (clinical and pathologic) and a prognostic stage group. Prognostic stage incorporates anatomic stage, plus tumor grade, hormone receptor status, and HER2 status. Thus, tumors bearing markers predictive of good prognosis with current treatment are effectively down-staged, while those with poorer prognostic markers are upstaged. In addition, the AJCC Breast Cancer Expert Panel also evaluated incorporation of multiparameter gene expression panels into staging classification. They determined that the evidence for the excellent prognosis of tumors with an Oncotype DX low-risk RS was strong enough that any ER+ HER2-negative node-negative tumor under 5 cm with RS < 11 should be downstaged to a Pathologic Prognostic Stage group of IA. The panel determined that, at this time, only the Oncotype DX assay had generated robust enough data to alter tumor stage. However, they recommended that results of other gene expression assays, when available, should be collected by data registries, and left open the possibility of future modification of the staging system if more data becomes available [5].
Skin cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
The AJCC staging system is the most widely used: Stage 0: Carcinoma in situ, confined to the epidermisStage I: <2 cm with no spread beyond skinStage II: >2 cm with no spread beyond skin, or any size with two or more or the following: Invasion into the lower dermis or subcutisNeural invasionTumours on the ear or a hair-bearing lipStage III: Involvement of facial bones or one nearby lymph node, but not to other organsStage IV: Any size with spread to one or more lymph nodes >3 cm or distant metastases
Primary bone tumours
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Two staging systems are in current use: the Musculoskeletal Tumor Society (MSTS) system (Table 22.4) and the American Joint Committee on Cancer (AJCC) system (Table 22.5). The staging system adopted by the MSTS for staging of bone tumours built on the work of Enneking (67). This stages malignant lesions according to the local extent (T), the grade (G), and the presence or absence of regional or distant metastases (M). In this system, neoplasms are divided into two grades: low (G1) and high (G2). The anatomic extent (T) is divided according to whether the lesion is intracompartmental (A) or extracompartmental (B). The presence or absence of metastasis (M) is the final component of this staging system. The system adopted by the AJCC is similar to that devised by Enneking; however, there have been a number of modifications. These include the replacement of intraosseous or extraosseous extent of tumour with tumour size, which is thought to be of more prognostic importance, location of metastases and whether they involve lung only or involve other locations including bone and skip metastases in the same bone. In the recently published, updated AJCC staging system, tumours with skip metastases are staged as stage IB or III based on grade (68).
Identification and validation of a novel prognostic circadian rhythm-related gene signature for stomach adenocarcinoma
Published in Chronobiology International, 2023
Lei Qian, Xiaochen Ding, Xiaoyan Fan, Shisen Li, Yihuan Qiao, Xiaoqun Zhang, Jipeng Li
Since the circadian rhythm-associated gene signature demonstrated robust predictive ability, we hypothesized that it could potentially be used as an independent prognosis indicator. Based on the TCGA clinical data of patients with STAD, we analyzed sex data, the Lauren classification, the American Joint Committee on Cancer (AJCC) staging system, and the circadian rhythm-associated gene signature using multifactorial Cox regression analysis. According to the Lauren classification system, gastric adenocarcinomas can be divided into diffuse, intestinal, and mixed type (Lauren 1965). The AJCC staging system, also called TNM classification, is used to characterize the burden of cancer tissue in the body based on the Tumor Node and Metastasis (TNM) profile, in which T describes the tumor size and any spreading into nearby tissues, N describes whether the cancer has spread to nearby lymph nodes, and M describes whether the cancer has spread to other parts of the body (metastasis). Multivariate Cox regression analysis showed that age, sex, M, and the circadian rhythm-associated gene signature were significant independent prognosis indicators (Figure 3A). Subsequently, we created a nomogram comprising these factors (Figure 3B) aiming to precisely forecast patient survival risk for precision medicine.
Assessment of the external validity of the American Joint Committee on Cancer 8th staging system for anal carcinoma
Published in Current Medical Research and Opinion, 2018
Hani Oweira, Anwar Giryes, Meinrad Mannhart, Michael Decker, Rolf Schlumpf, Omar Abdel-Rahman
In order to reach appropriate treatment decisions for anal carcinomas, a number of considerations need to be taken into account. These include age, co-morbidity and performance status of the patients as well as histology, biology and stage of the disease4,5. The most commonly utilized staging system for anal carcinoma is the American Joint Committee on Cancer (AJCC) staging system. Concurrent with the updates in the staging system of other solid tumors, the AJCC 8th edition updated its anal carcinoma staging system6. Changes in the 8th edition (compared to previous editions) included changes in some of the definitions of N stage (classifying node-positive patients into N1a, N1b and N1c in the 8th edition instead of N1, N2 and N3 in 6th/7th edition). Consequently, the stage grouping was changed to accommodate the changes in individual TNM. Table 1 summarizes the changes in the 8th edition compared to the 6th/7th edition (it has to be noted that there were no differences between the AJCC 6th and 7th editions).
Surgical Research Progress of Sentinel Lymph Node Biopsy in Melanoma
Published in Journal of Investigative Surgery, 2023
Pathological information pertaining to regional lymph nodes also constitutes a critical basis for tumor staging. In the eighth edition of the American Joint Committee on Cancer (AJCC) staging system, the N staging is further refined to encompass both the number and extent of lymph nodes affected within the tumor area, as well as the extent of metastasis beyond the nodal region. The presence of microsatellites, satellites, or in-transit metastases is classified as N1c, N2c, or N3c, respectively, based on the cumulative count of regional lymph nodes affected. Microsatellite metastases are defined as any microscopic lesions adjacent to or deep but noncontiguous with the primary tumor. Satellite metastases, on the other hand, refer to cutaneous or subcutaneous metastases occurring within 2 cm of the primary lesion but not directly connected to it. In-transit metastases are generally characterized as those located more than 2 cm away from the primary lesion, within the region spanning between the primary lesion and the regional lymph node basin [41].
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