AJCC Staging

—Greene FL, Stewart AK, Norton HJ. A new TNM staging strategy for node-positive (stage III) colon cancer: An analysis of 50,042 patients. Annals of Surgery 2002; 4:416-21. (!)

—Yarbro JW, Page DL, Fielding LP, Partridge EE, Murphy GP. American Joint Committee on Cancer prognostic factors consensus conference. Cancer 1999; 86:2436-2446. (!)

—Fleming ID, Phillips JL, Menck HR, Murphy GP, Winchester DP. The National Cancer Data Base report on recent hospital cancer program progress toward complete American Joint Committee on Cancer / TNM staging. Cancer 1997; 80(12):2305-10. (!)

American Joint Committee on Cancer (AJCC) staging procedures were first published in 1977. Since 1991, the Commission on Cancer (COC) has required AJCC staging of all non-pediatric cancers. The National Cancer Data Base (NCDB) has encouraged recording of AJCC staging through analyses of selected aspects of staging completeness. For this review, NCDB reports for nearly 2 million stageable cancers diagnosed from 1990 through 1994 were examined with emphasis on the hospital cancer program environment. Staging was complete if the hospital submitted codes for at least 90% of stageable cases or incomplete if the hospital submitted codes for fewer than 5%. (Stageable cases were those cases having site/histology combinations with defined staging procedures). Hospitals were classified by ownership and type of cancer program. Regional staging practices were also reviewed. Overall staging increased from 78% to 88%, with increases for every site except carcinomas of the skin, cancers of the extrahepatic bile ducts and urethra, melanoma of the eyelid, and retinoblastoma. The percent of hospitals staging completely increased from 49% to 61%, and the percent not routinely staging decreased from 6% to 3%. Complete staging increased in all hospital categories except For-Profit. The trend toward complete staging was uneven among states and regions. The authors concluded that hospital staging policies were affected by activities of the AJCC, COC, NCDB, clinical protocol procedures, and state policies. The varied completeness of staging at the hospital level by state, region, and type of hospital indicates that the adoption of routine staging is ongoing.

—Fleming ID, Phillips JL, Menck HR. The National Cancer Data Base report on completeness of American Joint Committee on Cancer staging in United States cancer facilities. Cancer 1996; 78:1498-504. (!)

American Joint Committee on Cancer (AJCC) staging is increasingly accepted as a prognostic standard for cancer management. The Commission on Cancer requires approved cancer programs to use AJCC staging for all cancers. Previous studies document increasing use of AJCC staging by hospitals with cancer programs. This review examined programmatic and clinical factors affecting AJCC staging completeness. The data were registry records submitted to the National Cancer Data Base for cases diagnosed during 1993 or, for comparison, 1988. The mean facility staging rate was 87% in 1993, up from 65% in 1988. Approximately 64% of facilities staged more than 90% of their stageable cases (cases having site and histology combinations with defined staging procedures); 3% staged less than 5% of stageable cases. Even facilities with "complete" staging implementation were unable to stage substantial portions of some sites. Accessibility of tumor and overall prognosis affected the choice between pathologic and clinical staging. Staging completeness and the mix of pathologic and clinical staging also differed by state of reporting facility. AJCC staging use is high among common tumors for which treatment is dependent upon stage of disease. However, if accurate staging is not expected to affect the treatment or outcome of the case or overall outcome is poor, staging is less frequently recorded.

—Henson DE, Johnson C. Trends in cancer staging. In: Steele GD, Jessup JM, Winchester DP, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1995. Atlanta, GA: American Cancer Society, 1995; 119-125.

In this report, we describe trends in the frequency of staging as reported in the National Cancer Data Base (NCDB) for 1992 data. As part of the effort to assess patient care, the NCDB has collected longitudinal data on the frequency of staging in the US by ethnic group, economic status, and type and size of reporting hospital. The frequency of staging (clinically, pathologically, or by both methods) has increased significantly since 1986- 1987. Between 1986-1987 and 1992, the percentage of unstaged cancers decreased from 46.3% to 15.8%. Staging aids in assessing the severity of disease, a process inherent in the practice of medicine. Since 1985, significant progress has been made toward increasing the frequency with which stage of disease is recorded in the medical record or in the tumor registry. In 1985/1986, only 52.8% of cancers recorded by hospitals participating in the NCDB were staged either clinically, pathologically, or by both methods, compared with 76.5% in 1990 and 84.2% in 1992. The frequency of staging by both pAJCC and cAJCC depends on the cancer site. Although the results reported herein were obtained from hospitals that agreed to participate in the NCDB, in all likelihood they also apply to hospitals that did not participate. It should be noted that the percentage of unstaged cancers reported by nonapproved hospitals (16.5%) was almost identical to that reported by teaching hospitals (16.3%).

—Henson DE, Menck HR. The National Cancer Data Base report on trends in cancer patient staging. Cancer 1994; 74:1974-1978.

—Henson DE, Menck HR, Zuber-Ocwieja KE. Trends in cancer patient staging. In: Steele GD, Winchester DP, Osteen RT, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1994. Atlanta, GA: American Cancer Society, 1994.

The data include records on 230,145 cases received from 464 hospitals in 1985, 235,365 cases from 474 hospitals in 1986, and 507,203 cases received from 937 hospitals in 1991. These data represent approximately 26%, 25%, and 46% of all incident cancers in the US in 1985, 1986, and 1991. In 1991, 82.5% of cases were staged either pathologically, clinically, or by both methods. In contrast, only 48.5% of 1985-1986 cases were staged. The percent of cases clinically staged or staged by both methods doubled between 1985-1986 and 1991. The 1991 figure of 82.5% represents an increase over 1990 data. Staging in minority populations improved; 78.1% of Hispanic and 82.3% of African-American cases were staged either clinically, pathologically, or by both methods. Income level seemed to have little effect on staging frequency. The sites most commonly staged were breast, uterine cervix, larynx, and colon.

—Henson DE, Menck HR. Time trends in cancer staging. In: Steele GD, Winchester DP, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1993. Atlanta, GA: American Cancer Society, 1993; 67-73.

The data include records from 486 hospitals for 1985, 597 hospitals for 1988, and 837 hospitals for 1990. Changes in the percentage of patients staged from 1985 to 1990 are included for all cancers except childhood, small intestine, vulva, vagina, eye, unknown primaries, multiple myeloma, and the leukemias. For all sites combined, the percentage of total cases staged (clinically, pathologically, or both) increased by 23.7% from 1985 through 1990. The number of cases staged pathologically, however, decreased from 1988 (45.4%) through 1990 (41.4%). Overall, there was an increase of 20.2 percentage points in the number of patients staged from 1985 through 1988, and an increase of 3.5 percentage points from 1988 through 1990. In 1990, cancers of the colon and breast were most frequently staged. Regionally, the highest percentage of staging occurred in the Pacific region (85%) and in the Mid-Atlantic (83.2%). The lowest percentage (64.5%) was seen in New England. Tables include staging method by year of diagnosis, primary site by year of diagnosis, ethnicity, geographic region, hospital caseload, and type of reporting hospital.

—Henson DE. Time trends in the use of TNM staging. In: Steele GD, Winchester DP, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1992. Atlanta, GA: American Cancer Society, 1992; 66-73.

This analysis of trends in use of TNM staging includes data from 598 hospitals throughout the United States, including 122,162 cases first diagnosed in 1985, and 254,628 cases in 1988. The data provides a longitudinal measure of TNM staging practices. Cases unstaged by site are grouped by geographic area, average family income, and special population (ethnicity).

 

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