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Version of Record online: 27 APR 2012
Copyright © 2012 American Cancer Society
Volume 118, Issue 22, pages 5535–5543, 15 November 2012
How to Cite
Zaorsky, N. G., Li, T., Devarajan, K., Horwitz, E. M. and Buyyounouski, M. K. (2012), Assessment of the American Joint Committee on Cancer Staging (sixth and seventh editions) for clinically localized prostate cancer treated with external beam radiotherapy and comparison with the National Comprehensive Cancer Network risk-stratification method. Cancer, 118: 5535–5543. doi: 10.1002/cncr.27597
Presented at the 2012 American Society of Clinical Oncology Genitourinary Cancer Symposium; February 2-4, 2012; San Francisco, CA.
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or Varian Medical Systems.
- Issue online: 30 OCT 2012
- Version of Record online: 27 APR 2012
- Manuscript Accepted: 12 MAR 2012
- Manuscript Revised: 8 MAR 2012
- Manuscript Received: 17 JAN 2012
- prostate cancer;
- American Joint Committee on Cancer;
- National Comprehensive Cancer Network
The objective of this study was to compare the prognostic value of the sixth and seventh editions of the American Joint Cancer Committee (AJCC) Cancer Staging Manual and the risk-stratification model of the National Comprehensive Cancer Network (NCCN).
Two-thousand four hundred twenty-nine men who received definitive radiotherapy with or without androgen-deprivation therapy (median follow-up, 74 months) were analyzed.
There was a migration of stage II patients to stage I with AJCC seventh edition (stage I increased from 1% to 38%, and stage II decreased from 91% to 55%). One pair-wise comparison (4%) of Kaplan-Meier estimates of biochemical failure, distant metastasis, prostate cancer-specific survival, and overall survival between stages was statistically significant for the AJCC sixth edition. Conversely, 16 of 24 comparisons (67%) were significant for the AJCC seventh edition. With the NCCN risk-stratification model, 9 of 12 comparisons (75%) were significant. Concordance probability estimate (CPE) and standard error (SE) analysis indicated uniform and significant improvement in the predictive power of the AJCC seventh edition versus the sixth edition for all outcomes. CPE ± SE values for the AJCC seventh edition versus the sixth edition were 0.51 ± 0.009 versus 0.59 ± 0.02, respectively, for biochemical failure; 0.54 ± 0.02 versus 0.70 ± 0.05, respectively, for distant metastasis; 0.57 ± 0.009 versus 0.76 ± 0.007, respectively, for prostate cancer-specific survival; and 0.52 ± 0.006 versus 0.57 ± 0.01, respectively, for overall survival. CPE ± SE values for the NCCN model were 0.59 ± 0.02 for biochemical failure, 0.72 ± 0.05 for distant metastasis, 0.80 ± 0.01 for prostate cancer-specific survival, and 0.57 ± 0.01 for overall survival.
The current results indicated that the seventh edition of the AJCC Cancer Staging Manual is a major improvement over the sixth edition, because it distributes patients better among the stages and is more prognostic. However, the NCCN model was superior to the AJCC seventh edition and remains the preferred method for risk-based clinical management of prostate cancer with radiotherapy. Cancer 2012. © 2012 American Cancer Society.