The American Joint Committee on Cancer (AJCC) staging manual has become the benchmark for classifying patients with cancer, defining prognosis, and determining the best treatment approaches. Many view the primary role of the tumor, lymph node, metastasis (TNM) system as that of a standardized classification system for evaluating cancer at a population level in terms of the extent of disease, both at initial presentation and after surgical treatment, and the overall impact of improvements in cancer treatment. The rapid evolution of knowledge in cancer biology and the discovery and validation of biologic factors that predict cancer outcome and response to treatment with better accuracy have led some cancer experts to question the utility of a TNM-based approach in clinical care at an individualized patient level. In the Eighth Edition of the AJCC Cancer Staging Manual, the goal of including relevant, nonanatomic (including molecular) factors has been foremost, although changes are made only when there is strong evidence for inclusion. The editorial board viewed this iteration as a proactive effort to continue to build the important bridge from a "population-based" to a more "personalized" approach to patient classification, one that forms the conceptual framework and foundation of cancer staging in the era of precision molecular oncology. The AJCC promulgates best staging practices through each new edition in an effort to provide cancer care providers with a powerful, knowledge-based resource for the battle against cancer. In this commentary, the authors highlight the overall organizational and structural changes as well as "what's new" in the Eighth Edition. It is hoped that this information will provide the reader with a better understanding of the rationale behind the aggregate proposed changes and the exciting developments in the upcoming edition. CA Cancer J Clin 2017;67:93-99. © 2017 American Cancer Society.

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The National Cancer Data Base (NCDB) is a nationwide oncology outcomes database that currently collects information on approximately 70% of all new invasive cancer diagnoses in the United States each year and serves as a powerful clinical surveillance and quality improvement mechanism for cancer programs participating in the American College of Surgeons (ACoS) Commission on Cancer (CoC) approvals program.1-3 Currently, the NCDB receives over one million cancer case reports annually from more than 1,430 hospitals. The NCDB now contains data on more than 21 million cancer patients diagnosed between 1985 and 2005, and is recognized as the largest clinical registry in the world. NCDB data are used to explore trends in cancer care, to examine regional and national benchmarks, and to serve as the basis for quality improvement activities ( http://www.facs.org/cancer/ncdb)The purposes of this review are: (1) to describe the NCDB and the data collected; (2) to discuss how the NCDB can be used to study clinical outcomes and the quality of cancer care in the United States; and (3) to describe the clinical care improvement tools provided by the NCDB and the CoC to participating hospitals.

The NCDB offers a critically important perspective on cancer care in the United States. To capitalize on its strengths and adjust for its limitations, investigators and their audiences should familiarize themselves with the advantages and shortcomings of the NCDB, as well as its evolution over time.

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