The need is growing for more accurate and probabilistic individualized outcome predictions for precision medicine, and so the American Joint Committee on Cancer (AJCC) has established first-of-its-kind guidelines for the practice of precision medicine. The guidelines will guide more precise treatment and lead to improved patient survival rates and outcomes. They were published in CA: A Cancer Journal for Clinicians.1

The AJCC has been developing anatomic staging systems since 1953, and, for solid malignancies, it is based on 3 criteria: the local extent of the cancer within the site of origin (T), the degree of metastatic involvement of the regional lymph nodes (N), and the presence or absence of distant metastatic disease (M).

Now, the AJCC is aiming to move beyond TNM. The new risk calculators, which are considered a complement to the existing staging system, will enable physicians to more accurately and precisely determine the best treatment for individual patients. AJCC is committed to enhancing the system with more prognostic, statistically based risk calculators in 2016.

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“This represents a new paradigm shift for the future of cancer treatments,” said Michael Kattan, PhD, MBA, chair of Cleveland Clinic’s Department of Quantitative Health Sciences at Cleveland Clinic’s Lerner Research Institute in Cleveland, Ohio. Dr Kattan led a discussion by a group of top health care statistical experts from across the country who form the Precision Medicine Core (PMC). They discussed characteristics necessary for developing a quality risk model in patients with cancer. The emphasis centered on performance metrics, implementation clarity, and clinical relevance.

The first cancers that will be evaluated for existing prediction models are breast, colon, prostate, lung, melanoma, and head and neck cancer. The goal is to comprehensively include all cancers in the future. Risk models must predict overall survival or death from a particular type of cancer and have to pass all 16 criteria, which include 13 inclusion and 3 exclusion criteria for the AJCC risk model endorsement in cancer.

“Our checklist should open the door to a wave of statistical prediction models that get used clinically across many different cancers,” said Dr Kattan, a pioneer in the development of cancer risk calculators called nomograms. “It could potentially be applied outside cancer as well, anywhere statistical prediction models are being considered for widespread usage.”

Next, authors of prediction models will receive the checklist of the 16 criteria and be invited to submit their models for consideration for inclusion by the AJCC. Eventually, AJCC inclusion will allow the models to be used in everyday practice.

“When the models get into physicians’ hands, the way patients are treated and managed and counseled will be forever changed for the better,” Dr Kattan said. “This is truly a great example of how precision medicine will help cancer patients in the not so distant future.”


1. Kattan MW, Hess KR, Amin MB, et al. American Joint Committee on Cancer acceptance criteria for inclusion of risk models for individualized prognosis in the practice of precision medicine [published online ahead of print January 19, 2016]. CA Cancer J Clin. doi: 10.3322/caac.21339.