LAUSR

The American Joint Committee on Cancer (AJCC) Staging Manual represents the standard for classifying patients with pancreas and hepatobiliary cancers, predicting prognosis, and guiding treatment decisions. For the new 8th edition, the AJCC Hepatobiliary Task Force, a multidisciplinary team of international experts, conducted two face-to-face meetings. At the first meeting, specialists in individual disease sites presented analysis of the literature and reviewed questions and issues from the 7th edition. Recommendations for revisions were proposed and discussed. At the second meeting, additional data to support the proposed revisions were reviewed, and revisions were approved by the full task force, including representatives from the Union for International Cancer Control (UICC) and the AJCC Editorial Board. Chapters were submitted to the Editorial Board for editing and final approval. The cornerstone of staging of hepatobiliary cancers is high-quality surgery, detailed pathologic analysis, and reliable follow-up, which are not available from large datasets and registries. Owing to the relative rarity of hepatobiliary cancers and the complex anatomy, often requiring technically demanding surgery, the AJCC staging system is largely based on single-institution series from centers of excellence in surgery and pathology. Much of the evidence that forms the basis for the revised 8th edition has been validated at other centers of excellence in hepatobiliary cancer. Importantly, the revisions also drew heavily on international expertise, particularly from Asia, where the incidence of hepatobiliary cancers is high. For the 8th edition, the N category has been harmonized for gallbladder, perihilar bile ducts, distal bile duct, ampulla, and pancreas. For these disease sites, N1 is defined as one to three metastatic lymph nodes, and N2 as four or more metastatic lymph nodes. A number-based categorization of metastatic lymph nodes results in better prognostic stratification. Other key modifications in the AJCC 8th edition are described below.