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ED05 - The 8th Edition of the TNM Staging System (ID 268)
- Event: WCLC 2016
- Type: Education Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:P. Goldstraw, R. Rami-Porta
- Coordinates: 12/05/2016, 16:00 - 17:30, Hall C1
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ED05.04 - What’s New in Esophageal Cancer Staging? (ID 6446)
17:05 - 17:25 | Author(s): T. Rice
- Abstract
- Presentation
Abstract:
What’s New in Esophageal Cancer Staging? Thomas W. Rice, MD The 8th edition cancer staging manuals will be published later this year,[1,2] and the new staging recommendations will go into effect January 1, 2017. Staging cancer of the esophagus and esophagogastric junction for the 8th edition of the AJCC/UICC manuals was developed on a strong 7th edition foundation.[3,4] A greatly enhanced Worldwide Esophageal Cancer Collaboration (WECC) database, with a substantial increase in both numbers of patients (22,654) entered and variables (39) collected,[5-7 ]permitted a more dynamic and dependable Random Forest–based machine learning analysis. Random Forest analyses provided risk-adjusted survival estimates for all patients, from which distinctive and homogeneous stage groups with monotonically decreasing survival were identified.[8-10] Cancer Categories There were no major changes in cancer categories; however, there were some important refinements for T, N, grade, and location. Subcategorization of pT1 into pT1a and pT1b enhanced and improved Stage I grouping. Regional lymph nodes (N) were clarified in a new and simplified map. Undifferentiated cancers now require additional analyses to expose histopathologic cell type. If glandular origin can be determined, the cancer is staged as Grade 3 adenocarcinoma; if squamous origin can be determined or if the cancer remains undifferentiated after full analysis, it is staged as Grade 3 squamous cell carcinoma. Cancer location, not important for adenocarcinoma stage grouping, in conjunction with grade is necessary to subgroup only pT3N0M0 squamous cell carcinoma. The definition of the esophagogastric junction was revised; cancers involving the esophagogastric junction with epicenters 2 cm or less into the gastric cardia are staged as adenocarcinomas of the esophagus, while those with more than 2-cm involvement are staged as stomach cancers. Stage Groupings Pathologic Stage Grouping (pTNM) Historically, pathologic stage after esophagectomy alone has been the sole basis for all cancer staging, regardless of classification (c, yc, yp, r, and a). Today, pathologic stage has lost some of its clinical relevance for advanced-stage cancer as neoadjuvant therapy replaces esophagectomy alone. However, it remains important for early-stage cancers and as a key reference point. Dissimilar stage group composition and survival profiles necessitated separate staging groupings for adenocarcinoma and squamous cell carcinoma. Neoadjuvant Pathologic Stage Grouping (ypTNM) New to the 8th edition is stage grouping of patients with esophageal cancers who have had neoadjuvant therapy and pathologic review of the resection specimen (ypTNM). Drivers of this addition include absence of equivalent pathologic (pTNM) categories for the peculiar neoadjuvant pathologic categories (ypT0N0-3M0 and ypTisN0-3M0), dissimilar stage group compositions, and markedly different survival profiles. Grade and location play no role in neoadjuvant pathologic stage grouping. The groupings are identical for both histopathologic cell types. Clinical Stage Grouping (cTNM) Also new to the 8th edition is clinical stage grouping (cTNM) prior to treatment decision. Clinical staging is done typically in the absence of complete histologic cancer data, because clinical TNM categories are typically defined by imaging and examination of needle aspiration and biopsy specimens. Dissimilar stage group composition and survival profiles necessitated clinical stage grouping (cTNM) distinct from pathologic stage grouping (pTNM). There is separate clinical staging for adenocarcinoma and squamous cell carcinoma. How to proceed with TNM-8? 8th edition staging for cancer of the esophagus and esophagogastric junction are data driven and expanded from pathologic stage (pTNM) to include also pathologic stage after neoadjuvant therapy (ypTNM) and clinical stage (cTNM) before treatment decision. Critical evaluation of 8th edition staging, intensive data collection, in-depth analyses, and further consensus appraisal are necessary to proceed from the 8th to the 9th edition. References 1) American Joint Committee on Cancer Staging Manual. 8th ed. In press. 2) TNM classifications of malignant tumors. International Union Against Cancer. 8[th] ed. In press. 3) Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. American Joint Committee on Cancer Staging Manual. 7th ed. New York: Springer-Verlag; 2010. 4) Sobin LH, Gospodarrowicz MK, Wittekind C, editors. TNM classifications of malignant tumors. International Union Against Cancer. 7th ed. Oxford, England: Wiley-Blackwell; 2009. 5) Rice TW, Chen L-Q, Hofstetter WL, et al. Worldwide Esophageal Cancer Collaboration: pathologic staging data. Dis Esophagus. In press. 6) Rice TW, Lerut TEMR, Orringer MB, et al. Worldwide Esophageal Cancer Collaboration: neoadjuvant pathologic staging data. Dis Esophagus. In press. 7) Rice TW, Apperson-Hansen C, DiPaola LM, et al. Worldwide Esophageal Cancer Collaboration: clinical staging data. Dis Esophagus. In press. 8) Rice TW, Ishwaran H, Hofstetter WL, Kelsen DP, Blackstone EH. Recommendations for pathologic staging (pTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. Dis Esophagus. In press. 9) Rice TW, Ishwaran H, Kelsen DP, Hofstetter WL, Blackstone EH. Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. Dis Esophagus. In press. 10)Rice TW, Ishwaran H, Blackstone EH, Hofstetter WL, Kelsen DP. Recommendations for clinical staging (cTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. Dis Esophagus. In press.
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IA05 - The Practical Use of the TNM Classifications for Thoracic Cancers (ID 291)
- Event: WCLC 2016
- Type: Interactive Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:H. Asamura, C. Herold
- Coordinates: 12/06/2016, 11:00 - 12:30, Hall C7
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IA05.04 - Esophageal Carcinoma Cases (ID 6527)
12:10 - 12:30 | Author(s): T. Rice
- Abstract
- Presentation
Abstract not provided
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