Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system
Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system
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DOI：
10.1200/jco.1997.15.3.1039
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发表时间：
1997-03-01
影响因子：
45.3
通讯作者：
Benjamin, RS
中科院分区：
文献类型：
--
作者：
Buzaid, AC;Ross, MI;Benjamin, RS
目的：对美国癌症联合委员会（AJCC）皮肤黑色素瘤分期系统的准确性进行评价，并提出一种更实用的分期系统。对已发表数据的回顾性评价以及对亚拉巴马大学和悉尼黑色素瘤单位（UAB/SMU）数据库的再分析（n = 4，568），以明确检查浸润和溃疡程度对肿瘤厚度预后价值的影响。此外，重叠图形技术被用来比较Kaplan-Meier生存曲线的患者局部复发，卫星，在途转移，淋巴结转移literature.Results：肿瘤厚度和溃疡仍然是最强大的预后指标，在患者的I期和II期疾病。浸润程度仅在肿瘤厚度小于或等于1 mm的患者亚组中提供具有统计学意义的预后信息，但10年生存率的绝对差异很小且不一致（II级，95%; III级，85%; IV级，89%）。肿瘤厚度临界值的最佳统计学拟合为1 mm、2 mm和4 mm。重叠图形技术显示，出现卫星病变或局部复发的患者的肿瘤与III期疾病患者相似。对于淋巴结转移患者来说，最重要的预后因素是受累淋巴结的数量而不是大小。结论：我们的分析表明，目前的AJCC分期系统存在许多不准确之处，应进行修改以符合已发表的数据。在我们分析和回顾文献的基础上，我们提出了一个新的和更准确的分期系统。(C)1997年，美国临床肿瘤学会。
Purpose: To critically review the accuracy of the current American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma and propose a more useful staging system.Methods: Retrospective evaluation of the published data as well as a reanalysis of the University of Alabama and Sydney Melanoma Unit (UAB/SMU) data bases (n = 4,568) for patients with primary melanoma was performed to examine specifically the impact of level of invasion and ulceration on the prognostic value of tumor thickness. In addition, an overlay graphic technique was used to compare the Kaplan-Meier survival curves of patients with local recurrences, satellites, in-transit metastases, and nodal metastases reported in the literature.Results: Tumor thickness and ulceration remained the most powerful prognostic indicators in patients with stage I and II disease. Level of invasion provided statistically significant prognostic information only in the subgroup of patients with tumor thickness less than or equal to 1 mm, but the absolute 10-year survival differences were small and inconsistent (level II, 95%; level III, 85%; level IV, 89%). The best statistical fit for tumor thickness cutoffs wets at 1 versus 2 versus 4 mm. The overlay graphic technique showed that patients who developed satellite lesions or local recurrence had prognoses similar to those of patients with stage III disease. The most important prognostic factor for patients with nodal metastases was number of involved nodes rather than size.Conclusion: Our analysis showed their the current AJCC staging system has many inaccuracies that should be modified to conform to published data. On the basis of our analysis and review of the literature, we propose a new and more accurate staging system. (C) 1997 by American Society of Clinical Oncology.