The Eighth Edition <scp>AJCC</scp> Cancer Staging Manual: Continuing to build a bridge from a population‐based to a more “personalized” approach to cancer staging

TLDR

The AJCC Cancer Staging Manual, the standard for classifying cancer patients and guiding prognosis and treatment, has traditionally relied on the TNM system but is increasingly challenged by advances in molecular biology that call for more individualized staging. This commentary outlines the structural revisions and rationale of the eighth edition, aiming to inform clinicians of the updated staging framework. The eighth edition prioritizes the incorporation of validated nonanatomic, including molecular, factors, marking a deliberate shift toward a precision‑oriented staging model. © 2017 American Cancer Society; CA Cancer J Clin 2017;67:93‑99.

Abstract

The American Joint Committee on Cancer (AJCC) staging manual has become the benchmark for classifying patients with cancer, defining prognosis, and determining the best treatment approaches. Many view the primary role of the tumor, lymph node, metastasis (TNM) system as that of a standardized classification system for evaluating cancer at a population level in terms of the extent of disease, both at initial presentation and after surgical treatment, and the overall impact of improvements in cancer treatment. The rapid evolution of knowledge in cancer biology and the discovery and validation of biologic factors that predict cancer outcome and response to treatment with better accuracy have led some cancer experts to question the utility of a TNM-based approach in clinical care at an individualized patient level. In the Eighth Edition of the AJCC Cancer Staging Manual, the goal of including relevant, nonanatomic (including molecular) factors has been foremost, although changes are made only when there is strong evidence for inclusion. The editorial board viewed this iteration as a proactive effort to continue to build the important bridge from a "population-based" to a more "personalized" approach to patient classification, one that forms the conceptual framework and foundation of cancer staging in the era of precision molecular oncology. The AJCC promulgates best staging practices through each new edition in an effort to provide cancer care providers with a powerful, knowledge-based resource for the battle against cancer. In this commentary, the authors highlight the overall organizational and structural changes as well as "what's new" in the Eighth Edition. It is hoped that this information will provide the reader with a better understanding of the rationale behind the aggregate proposed changes and the exciting developments in the upcoming edition. CA Cancer J Clin 2017;67:93-99. © 2017 American Cancer Society.