Final Version of 2009 AJCC Melanoma Staging and Classification
Final Version of 2009 AJCC Melanoma Staging and Classification
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DOI：
10.1200/jco.2009.23.4799
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发表时间：
2009-12-20
影响因子：
45.3
通讯作者：
Sondak, Vernon K.
中科院分区：
文献类型：
--
作者：
Balch, Charles M.;Gershenwald, Jeffrey E.;Sondak, Vernon K.
目的根据美国癌症联合委员会（AJCC）黑色素瘤分期数据库的数据修订皮肤黑色素瘤的分期系统。972例IV期黑色素瘤患者，以修订和澄清TNM分类和分期分组标准。（1）在局限性黑色素瘤患者中，肿瘤厚度、有丝分裂率（组织学定义为有丝分裂/mm（2））和溃疡是最主要的预后因素。(2)有丝分裂率取代浸润程度作为定义T1 b黑色素瘤的主要标准。(3)在3，307例区域转移患者中，定义N类别的组成部分是转移性淋巴结数量、肿瘤负荷和原发性黑色素瘤溃疡。(4)出于分期目的，所有存在显微镜下淋巴结转移的患者，无论肿瘤负荷程度如何，均被归类为III期。特别包括通过免疫组织化学检测的微转移。(5)在多变量分析的基础上，患者的远处转移，两个主要组成部分在定义的M类仍然是该网站的远处转移（非内脏v肺v所有其他内脏转移部位）和血清乳酸脱氢酶水平升高。结论使用循证医学的方法，修订AJCC黑色素瘤分期系统，反映了我们对这种疾病的认识提高。这些修订将正式纳入AJCC癌症分期手册第七版（2009年），并于2010年初实施。
Purpose To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database.Methods The melanoma staging recommendations were made on the basis of a multivariate analysis of 30,946 patients with stages I, II, and III melanoma and 7,972 patients with stage IV melanoma to revise and clarify TNM classifications and stage grouping criteria.Results Findings and new definitions include the following: (1) in patients with localized melanoma, tumor thickness, mitotic rate (histologically defined as mitoses/mm(2)), and ulceration were the most dominant prognostic factors. (2) Mitotic rate replaces level of invasion as a primary criterion for defining T1b melanomas. (3) Among the 3,307 patients with regional metastases, components that defined the N category were the number of metastatic nodes, tumor burden, and ulceration of the primary melanoma. (4) For staging purposes, all patients with microscopic nodal metastases, regardless of extent of tumor burden, are classified as stage III. Micrometastases detected by immunohistochemistry are specifically included. (5) On the basis of a multivariate analysis of patients with distant metastases, the two dominant components in defining the M category continue to be the site of distant metastases (nonvisceral v lung v all other visceral metastatic sites) and an elevated serum lactate dehydrogenase level.Conclusion Using an evidence-based approach, revisions to the AJCC melanoma staging system have been made that reflect our improved understanding of this disease. These revisions will be formally incorporated into the seventh edition (2009) of the AJCC Cancer Staging Manual and implemented by early 2010.