{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:07:02Z","timestamp":1787026022462,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CA A Cancer J Clinicians"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The standard for cancer staging in the United States for all cancer sites, including primary carcinomas of the appendix, is the American Joint Committee on Cancer (AJCC) staging system. AJCC staging criteria undergo periodic revisions, led by a panel of site\u2010specific experts, to maintain contemporary staging definitions through the evaluation of new evidence. Since its last revision, the AJCC has restructured its processes to include prospectively collected data because large data sets have become increasingly robust and available over time. Thus survival analyses using AJCC eighth edition staging criteria were used to inform stage group revisions in the version 9 AJCC staging system, including appendiceal cancer. Although the current AJCC staging definitions were maintained for appendiceal cancer, incorporating survival analysis into the version 9 staging system provided unique insight into the clinical challenges in staging rare malignancies. This article highlights the critical clinical components of the now published version 9 AJCC staging system for appendix cancer, which (1) justified the separation of three different histologies (non\u2010mucinous, mucinous, signet\u2010ring cell) in terms of prognostic variance, (2) demonstrated the clinical implications and challenges in staging heterogeneous and rare tumors, and (3) emphasized the influence of data limitations on survival analysis for low\u2010grade appendiceal mucinous neoplasms.<\/jats:p>","DOI":"10.3322\/caac.21806","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T09:10:05Z","timestamp":1687770605000},"page":"590-596","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Survival outcomes used to validate version 9 of the American Joint Committee on Cancer staging system for appendiceal cancer"],"prefix":"10.3322","volume":"73","author":[{"given":"Lauren M.","family":"Janczewski","sequence":"first","affiliation":[{"name":"Department of Surgery Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"American College of Surgeons Cancer Programs  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda E.","family":"Browner","sequence":"additional","affiliation":[{"name":"American College of Surgeons Cancer Programs  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph H.","family":"Cotler","sequence":"additional","affiliation":[{"name":"American College of Surgeons Cancer Programs  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Nelson","sequence":"additional","affiliation":[{"name":"American College of Surgeons Cancer Programs  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Kakar","sequence":"additional","affiliation":[{"name":"Department of Pathology University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman J.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Pathology Basingstoke and North Hampshire Hospital  Basingstoke UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader N.","family":"Hanna","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreana N.","family":"Holowatyj","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"West Virginia University Cancer Institute  Morgantown West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Kay","family":"Washington","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0176-3865","authenticated-orcid":false,"given":"Elliot A.","family":"Asare","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Utah Huntsman Cancer Institute  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Overman","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the American Joint Committee on Cancer Expert Panel on Cancers for the Lower Gastrointestinal Appendix Disease Site","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/coc.0000000000000210"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-014-2726-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrac103"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32793"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29744"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.epi-20-1505"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40618-3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf02236899"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21388"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07213-1"},{"key":"e_1_2_7_12_1","unstructured":"OvermanMJ KakarS CarrNJ et\u00a0al.AJCC Cancer Staging System: Appendix: AJCC Cancer Staging System. Version 9. American Joint Committee on Cancer American College of Surgeons;2022."},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10589"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.102199"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2022.07.004"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.13324"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19951201)76:11<2383::aid-cncr2820761130>3.0.co;2-6"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200308000-00006"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/pas.0b013e3181af6067"},{"key":"e_1_2_7_20_1","volume-title":"WHO Classification of Tumors of the Digestive System","author":"Bosman FT","year":"2010"},{"key":"e_1_2_7_21_1","first-page":"144","volume-title":"World Health Organization Classification of Tumours","author":"Misdraji J","year":"2019"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0b013e318269d680"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2014.37"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2017.09.005"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-008-0774-6"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2017.12.027"}],"container-title":["CA: A Cancer Journal for Clinicians"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.3322\/caac.21806","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T17:04:17Z","timestamp":1762362257000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.3322\/caac.21806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,26]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.3322\/caac.21806"],"URL":"https:\/\/doi.org\/10.3322\/caac.21806","archive":["Portico"],"relation":{},"ISSN":["0007-9235","1542-4863"],"issn-type":[{"value":"0007-9235","type":"print"},{"value":"1542-4863","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,26]]},"assertion":[{"value":"2023-03-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}