Reacting to Changes in Staging Designations in the 7th Edition of the AJCC Staging Manual

Excerpt

The American Joint Commission on Cancer (AJCC) staging manual was recently revised to reflect ongoing advances in the ability to stratify tumors by prognosis.1 For a number of tumor types, the T, N, and M staging parameters that form the backbone of the stage classification system were either redefined or reassigned to alternate stage groups. As a result, the same tumor might be given a stage classification in the revised (7th edition) manual that is either higher or lower than the stage classification of the previous (6th edition) staging manual. This apparent “upstaging” or “downstaging” of tumors by the revised manual has led to our referring to these tumors as the “stage shifters.” For example, a 7.1-cm, node-negative non-small cell lung cancer (NSCLC) considered stage IB in the 6th edition is now considered stage IIB. A T3 esophageal cancer with a single celiac lymph node metastasis considered stage IV in the 6th edition has been reclassified stage IIIA in the 7th edition. In soft tissue sarcomas N1 tumors were reclassified from stage IV to stage III, and melanoma that is metastatic to lymph nodes from an unknown primary has been reclassified from stage IV to III. …