Survival outcomes used to validate version 9 of the American Joint Committee on Cancer staging system for appendiceal cancer

Sep 24, 2026

Survival analyses were used to inform stage group revisions in the version 9 American Joint Committee on Cancer (AJCC) staging system, with a focus on appendiceal cancer. While AJCC definitions were maintained, incorporating survival analysis offered insight into clinical challenges in staging rare malignancies. The article details how version 9 justified separating three histologies by prognostic differences, demonstrated implications for heterogeneous tumors, and highlighted how data limitations affect survival estimates for low-grade appendiceal mucinous neoplasms.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

AJCC staging updates and survival-based rationale

Clinical implications for appendiceal cancer

Histology separation and data limitations

Author Manuscript Author Manuscript Author Manuscript Author Manuscript | | HHS Public Access
Author manuscript
CA Cancer J Clin. Author manuscript; available in PMC 2025 March 29. | | --- | --- | Published in final edited form as: CA Cancer J Clin. 2023 ; 73(6): 590–596. doi:10.3322/caac.21806 . Survival outcomes used to validate version 9 of the American Joint Committee on Cancer staging system for appendiceal cancer Lauren M. Janczewski, MD, MS 1,2 , Amanda E. Browner, MS2 , Joseph H. Cotler, PhD2 , Heidi Nelson, MD2 , Sanjay Kakar, MD3 , Norman J. Carr, MBBS4 , Nader N. Hanna, MD5 , Andreana N. Holowatyj, PhD, MS6 , Richard M. Goldberg, MD7 , M. Kay Washington, MD, PhD8 , Elliot A. Asare, MD, MS9 , Michael J. Overman, MD 10 , American Joint Committee on Cancer Expert Panel on Cancers for the Lower Gastrointestinal Appendix Disease Site2 1 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA 2American College of Surgeons Cancer Programs, Chicago, Illinois, USA 3 Department of Pathology, University of California San Francisco, San Francisco, California, USA 4 Department of Pathology, Basingstoke and North Hampshire Hospital, Basingstoke, UK 5 Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA 6 Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA 7West Virginia University Cancer Institute, Morgantown, West Virginia, USA 8 Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 9 Department of Surgery, University of Utah Huntsman Cancer Institute, Salt Lake City, Utah, USA 10 Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Abstract This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution-in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Correspondence Elliot A. Asare, AJCC Editorial Committee, American Joint Committee on Cancer, 633 N. Saint Clair, Chicago, IL 60611, [USA. elliot.asare@hci.utah.edu](USA. elliot.asare@hci.utah.edu). CONFLICT OF INTEREST STATEMENT Andreana N. Holowatyj reports grants from The Dalton Family Foundation, the National Institutes of Health (NIH), and Pfizer Inc. during the conduct of this study; grants from the American Cancer Society and the Appendix Cancer Pseudomyxoma Peritonei (ACPMP) Research Foundation outside the submitted work; personal fees from MJH Life Sciences outside the submitted work; and chairs the scientific advisory board for the ACPMP Research Foundation. Richard M. Goldberg reports personal fees from Adaptimmune, AstraZeneca, Bayer, Compass Therapeutics Inc., Focal Medical, G1 Therapeutics, Genentech, GlaxoSmithKline, Haystack Oncology, Innovative Cellular Therapeutics Inc., Merck, Sorrento Therapeutics, Taiho Oncology Inc., and Wolters Kluwer Health outside the submitted work; owns stock options in Focal Medical and Haystack Oncology; and owns stock in Compass Therapeutics Inc. Sanjay Kakar reports personal fees from Path AI outside the submitted work. Michael J. Overman reports personal fees from UpToDate outside the submitted work. The remaining authors disclosed no conflicts of interest. Author Manuscript Author Manuscript Author Manuscript Author Manuscript Janczewski et al. Page 2 The standard for cancer staging in the United States for all cancer sites, including primary carcinomas ofthe appendix, is the American Joint Committee on Cancer (AJCC) staging system. AJCC staging criteria undergo periodic revisions, led by a panel of site-specific experts, to maintain contemporary staging definitions through the evaluation of new evidence. Since its last revision, the AJCC has restructured its pr

FAQs

What is the purpose of the study for AJCC version 9 in appendiceal cancer?

To use survival outcomes to validate and support stage group revisions in the AJCC version 9 staging system for appendiceal cancer.

Which histologies were separated in AJCC version 9 and why?

Three histologies—non-mucinous, mucinous, and signet-ring cell—were separated based on prognostic variance shown through the analyses.

How does the article describe the role of data limitations in survival analysis?

It emphasizes that limitations in available data influence survival analysis results, particularly for low-grade appendiceal mucinous neoplasms.

Sep 24, 2026

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