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Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer.
Literature Information
| DOI | 10.3322/caac.21780 |
|---|---|
| PMID | 37114458 |
| Journal | CA: a cancer journal for clinicians |
| Impact Factor | 232.4 |
| JCR Quartile | Q1 |
| Publication Year | 2023 |
| Times Cited | 13 |
| Keywords | American Joint Committee on Cancer (AJCC) version 9, anal cancer, cancer prognostication, principles of cancer staging, staging/tumor/node/metastasis (TNM) classification |
| Literature Type | Journal Article, Review |
| ISSN | 0007-9235 |
| Pages | 516-523 |
| Issue | 73(5) |
| Authors | Lauren M Janczewski, Joseph Faski, Heidi Nelson, Marc J Gollub, Cathy Eng, James D Brierley, Joel M Palefsky, Richard M Goldberg, M Kay Washington, Elliot A Asare, Karyn A Goodman |
TL;DR
The American Joint Committee on Cancer (AJCC) has updated its staging system for anal cancer in version 9, incorporating new evidence and large data sets that reveal significant prognostic implications; notably, the reclassification of stage IIB and IIIA reflects that tumor category (T) is a more critical determinant of survival than lymph node involvement (N). These revisions aim to enhance the accuracy of cancer staging and improve patient outcomes by aligning with contemporary long-term survival data.
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American Joint Committee on Cancer (AJCC) version 9 · anal cancer · cancer prognostication · principles of cancer staging · staging/tumor/node/metastasis (TNM) classification
Abstract
The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including anal cancer, is the standard for cancer staging in the United States. The AJCC staging criteria are dynamic, and periodic updates are conducted to optimize AJCC staging definitions through a panel of experts charged with evaluating new evidence to implement changes. With greater availability of large data sets, the AJCC has since restructured and updated its processes, incorporating prospectively collected data to validate stage group revisions in the version 9 AJCC staging system, including anal cancer. Survival analysis using AJCC eighth edition staging guidelines revealed a lack of hierarchical order in which stage IIIA anal cancer was associated with a better prognosis than stage IIB disease, suggesting that, for anal cancer, tumor (T) category has a greater effect on survival than lymph node (N) category. Accordingly, version 9 stage groups have been appropriately adjusted to reflect contemporary long-term outcomes. This article highlights the changes to the now published AJCC staging system for anal cancer, which: (1) redefined stage IIB as T1-T2N1M0 disease, (2) redefined stage IIIA as T3N0-N1M0 disease, and (3) eliminated stage 0 disease from its guidelines altogether.
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Primary Questions Addressed
- How do the survival outcomes for anal cancer compare with those of other cancer types in the AJCC staging system?
- What specific data sets were utilized to validate the changes made in the version 9 AJCC staging system for anal cancer?
- How might the changes in the AJCC staging system impact treatment protocols for patients diagnosed with anal cancer?
- What are the implications of the revised definitions of stage IIB and IIIA for clinical practice and patient prognosis?
- In what ways does the elimination of stage 0 disease from the AJCC guidelines reflect evolving understanding of anal cancer progression?
Key Findings
1. Research Background and Objectives
The American Joint Committee on Cancer (AJCC) staging system serves as a crucial framework for categorizing cancer stages across various cancer types, including anal cancer. As cancer treatment and understanding evolve, the AJCC recognizes the necessity to periodically update these staging criteria to reflect new evidence and improve prognostic accuracy. This study aims to address deficiencies in the previous eighth edition staging guidelines for anal cancer, particularly concerning the prognostic implications of tumor and lymph node categories. The objective is to refine the staging system to enhance its predictive validity for survival outcomes in anal cancer patients.
2. Key Methods and Findings
The study employed survival analysis using data collected under the AJCC eighth edition staging guidelines, revealing inconsistencies in prognostic outcomes, such as stage IIIA anal cancer showing a better prognosis than stage IIB. This unexpected finding indicated that the existing hierarchical structure did not accurately reflect survival probabilities. To address these discrepancies, the AJCC implemented a refined version 9 staging system for anal cancer, incorporating contemporary long-term survival data. The revisions included: redefining stage IIB as T1-T2N1M0, redefining stage IIIA as T3N0-N1M0, and the complete removal of stage 0 disease from the guidelines. These changes were informed by a thorough evaluation of large, prospectively collected data sets that provided a more accurate representation of patient outcomes.
3. Core Conclusions
The revised AJCC version 9 staging system for anal cancer is a significant advancement toward accurately reflecting the prognostic landscapes of different cancer stages. The alterations to the definitions for stages IIB and IIIA enhance the clarity of the staging criteria, ensuring that the tumor category (T) is prioritized in determining survival outcomes over lymph node involvement (N). This restructuring aligns the staging system more closely with actual patient survival rates, thus providing a more reliable tool for clinicians in both diagnosis and treatment planning.
4. Research Significance and Impact
The implications of this research are profound for clinical practice and cancer management. By updating the AJCC staging criteria, healthcare providers are better equipped to make informed treatment decisions based on accurate prognostic information. The removal of stage 0 and the reclassification of existing stages reduce confusion and improve the accuracy of treatment recommendations, potentially leading to better patient outcomes. Furthermore, the incorporation of large data sets into the staging process exemplifies a shift towards evidence-based medicine, emphasizing the importance of ongoing research and data analysis in refining cancer care practices. Overall, these changes contribute to a more effective framework for managing anal cancer, ultimately aiming to improve survival rates and quality of life for patients.
Literatures Citing This Work
- The accuracy of anal self- and companion exams among sexual minority men and transgender women: a prospective analysis. - Alan G Nyitray;Timothy L McAuliffe;Cameron Liebert;Michael D Swartz;Ashish A Deshmukh;Elizabeth Y Chiao;Lou Weaver;Ellen Almirol;Jared Kerman;John A Schneider;J Michael Wilkerson;Lu-Yu Hwang;Derek Smith;Aniruddha Hazra; - Lancet regional health. Americas (2024)
- Prognostic evaluation of a multi-target magnetic bead-enriched circulating tumor cell-enriched identification system for colorectal cancer. - Yanfu Wang;Lu Xia;Mei Wu;Chunjin Huang - Journal of gastrointestinal oncology (2024)
- Prognostic Significance of Bulky Nodal Disease in Anal Cancer Management: A Multi-institutional Study. - Seok-Joo Chun;Eunji Kim;Won Il Jang;Mi-Sook Kim;Hyun-Cheol Kang;Byoung Hyuck Kim;Eui Kyu Chie - Cancer research and treatment (2024)
- Updates on the Version 9 American Joint Committee on Cancer Staging System for Anal Cancer. - Lauren M Janczewski;Elliot A Asare;Karyn A Goodman - Annals of surgical oncology (2024)
- Comparison of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma treated nonsurgically and proposal of a new stage grouping system. - Aihong Zheng;Yiwen Wang;Shuang Li;Yingjie Wang;Hong'en Xu;Jieni Ding;Bingchen Chen;Tao Song;Lei Lai - Cancer medicine (2024)
- Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters. - Hema Sekhar;Rohit Kochhar;Bernadette Carrington;Thomas Kaye;Damian Tolan;Lee Malcomson;Mark P Saunders;Matthew Sperrin;David Sebag-Montefiore;Marcel van Herk;Andrew G Renehan - British journal of cancer (2024)
- Carboplatin and Paclitaxel Chemoradiation for Localized Anal Cancer in Patients Not Eligible for Mitomycin and 5-Fluorouracil. - Alyssa K DeZeeuw;Michael F Bassetti;Evie H Carchman;Charles P Heise;Dana Hayden;Elise H Lawson;Cristina B Sanger;Ray King;Noelle K LoConte;Sam J Lubner;Jeremy D Kratz;Dustin A Deming - Cancers (2024)
- Concerning "Updates on the Version 9 American Joint Committee on Cancer Staging System for Anal Cancer": Is the Anal Physical Examination Underestimated? - Roberto Zinicola;Lorenzo Viani;Matteo Rossini;Federico Cozzani - Annals of surgical oncology (2025)
- Comparative evaluation of TNM staging systems (eighth vs. ninth edition) for the non-surgical treatment of localized and locally advanced anal squamous cell carcinoma: Prognostic significance of T classification and lymph node status. - Aihong Zheng;Hong'en Xu;Yiming Tao;Bingchen Chen;Jieni Ding;Tao Song;Yanwei Lu - PloS one (2025)
- Metastatic Status and Dissection Effect of Regional/Extraregional Lymph Nodes in Japanese Patients with Squamous Cell Carcinoma of the Anal Canal: A Multicenter Retrospective Cohort Study. - Takayuki Torigoe;Keiji Hirata;Kazutaka Yamada;Yoichi Ajioka;Kenichi Sugihara - Journal of the anus, rectum and colon (2025)
... (3 more literatures)
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