Evaluation of AJCC Tumor Staging for Cutaneous Squamous Cell Carcinoma and a Proposed Alternative Tumor Staging System
Evaluation of AJCC Tumor Staging for Cutaneous Squamous Cell Carcinoma and a Proposed Alternative Tumor Staging System
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DOI：
10.1001/jamadermatol.2013.2456
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发表时间：
2013-04-01
期刊：
影响因子：
10.9
通讯作者：
Schmults, Chrysalyne D.
中科院分区：
文献类型：
--
作者：
Jambusaria-Pahlajani, Anokhi;Kanetsky, Peter A.;Schmults, Chrysalyne D.
目的：确定皮肤鳞状细胞癌预后不良的危险因素，并评估2010年美国癌症联合委员会肿瘤(T)分期系统对这些结果分层的能力。设计：回溯性队列研究。设置：单一学术医院。参与者：通过病理学和皮肤病理学数据库搜索被诊断为高危CSCC的患者。结果：纳入256例原发高危CSCC患者。AJCC肿瘤T2到T4期的结果在统计学上是不可区分的，因为只有4例(=2厘米，侵犯皮下脂肪以外)包括0个因素T1，1个因素T2a，2到3个因素T2b，4个因素或骨侵犯，T3。T2a期和T2b期在所有4个终点的发生率均有显著差异。T2b期肿瘤仅占队列的19%，但占72%的淋巴结转移和83%的CSCC死亡。结论和相关性：建议的替代肿瘤分期系统通过T2期肿瘤的分层提供了更好的预后区分。需要在其他队列中进行验证。同时，T2b期肿瘤是大多数不良预后的原因，可能是高危CSCC研究的重点。
Importance: This study proposes an alternative tumor staging system for cutaneous squamous cell carcinoma (CSCC) that more precisely defines the small subset of tumors with a high risk of metastasis and death.Objective: To identify risk factors for poor outcomes in CSCC and evaluate the 2010 American Joint Committee on Cancer (AJCC) tumor (T) staging system's ability to stratify occurrence of these outcomes.Design: Retrospective cohort study.Setting: A single academic hospital.Participants: Study participants were identified via a pathology and dermatopathology database search for patients diagnosed as having high-risk CSCC.Results: Two hundred fifty-six primary high-risk CSCCs were included. Outcomes for AJCC tumor stages T2 to T4 were statistically indistinguishable because only 4 cases (= 2 cm, invasion beyond subcutaneous fat) were incorporated in the alternative staging with 0 factors indicating T1, 1 factor indicating T2a; 2 to 3 factors, T2b; and 4 factors or bone invasion, T3. Stages T2a and T2b significantly differed in incidences of all 4 end points. Stage T2b tumors comprised only 19% of the cohort but accounted for 72% of nodal metastases and 83% of deaths from CSCC.Conclusions and Relevance: The proposed alternative tumor staging system offers improved prognostic discrimination via stratification of stage T2 tumors. Validation in other cohorts is needed. Meanwhile, stage T2b tumors are responsible for most poor outcomes and may be a focus of high-risk CSCC study.