Validation of the AJCC 8th lung cancer staging system among patients with small cell lung cancer
The current study tried to validate the prognostic significance of the 8th American Joint Committee on Cancer (AJCC) staging system among small cell lung cancer (SCLC) patients recorded within the surveillance, epidemiology, and end results (SEER) database.
Patients and methods
SEER database (2004–2014) has been queried through SEER*Stat program, and both AJCC 7th and 8th edition stages were constructed. Cancer-specific and overall survival analyses according to both editions were performed through Kaplan–Meier analysis. The cause-specific Cox regression hazard for both AJCC editions (adjusted for age, gender, race, and surgery) was calculated and pair-wise comparisons of hazard ratios were conducted.
A total of 39,286 patients with SCLC were recruited in the period from 2004 to 2014. For overall and cancer-specific survival assessment, according to the AJCC 7th edition, P values for all pair-wise comparisons among different stages were significant (<0.0001) except for the comparisons between stage IB vs. stage IIA, and stage IIB vs. stage IIIA. For overall survival assessment, according to AJCC 8th, P values for all pair-wise comparisons were significant (<0.05) except for IA2 vs. IA3, IA3 vs. IB, IB vs. IIA, IIA vs. IIB, and IIIB vs. IIIC. For cancer-specific survival, according to AJCC 8th, P values for all pair-wise comparisons among different stages were significant (<0.05) except IA1 vs. IA2, IA2 vs. IA3, and IIA vs. IIB. When conducting pair-wise hazard ratio comparisons among different AJCC stages (for both editions), similar findings to the Kaplan–Meier analyses were reported.
While there is a clear improvement for both the AJCC 7th and 8th systems compared to the old veterans’ administration system, there is a modest improvement for the 8th compared to the 7th system among patients with SCLC.
KeywordsSCLC Staging AJCC SEER
Compliance with ethical standards
This study was not funded.
Conflict of interest
The author declares that there is no competing interest.
This article does not contain any studies with human participants or animals performed by the author.
As this study is based on a publicly available database without identifying patient information, informed consent was not needed.
- 1.http://globocan.iarc.fr. Accessed 27 Nov 2016.
- 7.Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2(8):706–14.CrossRefPubMedGoogle Scholar
- 8.Nicholson AG, Chansky K, Crowley J, Beyruti R, Kubota K, Turrisi A, et al. The International Association for the study of lung cancer lung cancer staging project: proposals for the revision of the clinical and pathologic staging of small cell lung cancer in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11(3):300–11.Google Scholar
- 9.Abdel-Rahman O. Validation of the prognostic value of new sub-stages within the AJCC 8th edition of non-small cell lung cancer. Clin Transl Oncol. 2017. doi: 10.1007/s12094-017-1673-7.
- 10.Chansky K, Detterbeck FC, Nicholson AG, Rusch VW, Vallieres E, Groome P, et al. The IASLC lung cancer staging project: external validation of the revision of the TNM stage groupings in the eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2017;12(7):1109–21. doi: 10.1016/j.jtho.2017.04.011.
- 11.Surveillance, Epidemiology, and End Results (SEER) Program (http://www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 18 Regs Custom Data (with additional treatment fields), Nov 2016 Sub (1973–2014 varying)—Linked To County Attributes—Total U.S., 1969–2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission.
- 17.Rena O, Massera F, Robustellini M, Papalia E, Delfanti R, Lisi E. Use of the proposals of the international association for the study of lung cancer in the forthcoming edition of lung cancer staging system to predict long-term prognosis of operated patients. Cancer J. 2010;16(2):176–81.CrossRefPubMedGoogle Scholar