Research Papers:

Evaluation of the 7th and 8th editions of the AJCC/UICC TNM staging systems for lung cancer in a large North American cohort

Lin Yang, Shidan Wang, Yunyun Zhou, Sunny Lai, Guanghua Xiao, Adi Gazdar _ and Yang Xie

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Oncotarget. 2017; 8:66784-66795. https://doi.org/10.18632/oncotarget.18158

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Lin Yang1,2, Shidan Wang2, Yunyun Zhou2,3, Sunny Lai2, Guanghua Xiao2, Adi Gazdar4,5 and Yang Xie2

1 Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

2 Department of Clinical Sciences, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA

3 Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA

4 Hamon Center for Therapeutic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

5 Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

Correspondence to:

Adi Gazdar, email:

Yang Xie, email:

Keywords: non-small cell lung cancer, AJCC/UICC staging system, national cancer database, survival analysis, external validation

Received: February 15, 2017 Accepted:April 04, 2017 Published: May 24, 2017


Purpose: The new 8th American Joint Committee on Cancer (AJCC)/International Union for Cancer Control (UICC) lung cancer staging system was developed and internally validated using the International Association for the Study of Lung Cancer (IASLC) database, but external validation is needed. The goal of this study is to validate the discriminatory ability and prognostic performance of this new staging system in a larger, independent non-small cell lung cancer (NSCLC) cohort with greater emphasis on North American patients.

Methods: A total of 858,909 NSCLC cases with one malignant primary tumor collected from 2004 to 2013 in the National Cancer Database (NCDB) were analyzed. The primary coding guidelines of the Collaborative Staging Manual and Coding Instructions for the new 8th edition AJCC/UICC lung cancer staging system was used to define the new T, M and TNM stages for all patients in the database. Kaplan-Meier curves, Cox regression models and time-dependent receiver operating characteristics were used to compare the discriminatory ability and prognostic performance of the 7th and the revised 8th T, M categories and overall stages.

Results: We demonstrated that the 8th staging system provides better discriminatory ability than the 7th staging system and predicts prognosis for NSCLC patients using the NCDB. There were significant survival differences between adjacent groups defined by both clinical staging and pathologic staging systems. These staging parameters were significantly associated with survival after adjusting for other factors.

Conclusions: The updated T, M, and overall TNM stage of the 8th staging system show improvement compared to the 7th edition in discriminatory ability between adjacent subgroups and are independent predictors for prognosis.

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