Kim Christina J, Reintgen Douglas S, Balch Charles M
Department of Surgery, H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida, Tampa, USA.
Cancer Control. 2002 Jan-Feb;9(1):9-15. doi: 10.1177/107327480200900102.
Classification schemas for cancers are useful for predicting overall survival and selecting patients for treatment. Historically, the most important factors in determining prognosis in patients with melanoma have been tumor thickness and lymph node status. Sentinel lymph node mapping defines a subset of patients with microscopic metastatic disease can be identified, offering greater accuracy in staging.
The authors reviewed studies evaluating the prognostic factors that are significant in predicting survival in patients with melanoma. The newly revised American Joint Committee on Cancer (AJCC) staging system for melanoma is compared with the 1997 AJCC staging system currently in use.
The changes in the new AJCC melanoma staging system reflect the new prognostic factors that have been found to be important in predicting survival. These include primary tumor thickness (tumor depth in millimeters is more predictive than the level of invasion) and ulceration, number of metastatic lymph nodes, micrometastatic disease based on the sentinel lymph node biopsy technique or elective node dissection, the site(s) of distant metastatic disease and serum LDH levels.
Major revisions have been made to form a new AJCC staging system for melanoma, which will become official in 2002. This system will provide more accurate and precise information regarding patient prognosis. Validation studies are needed to confirm the accuracy of this revised staging system.
癌症分类方案有助于预测总体生存率并为患者选择治疗方案。从历史上看，决定黑色素瘤患者预后的最重要因素是肿瘤厚度和淋巴结状态。前哨淋巴结定位可确定一部分存在微小转移疾病的患者，从而在分期方面提供更高的准确性。
作者回顾了评估对黑色素瘤患者生存有显著预测作用的预后因素的研究。将新修订的美国癌症联合委员会（AJCC）黑色素瘤分期系统与目前使用的1997年AJCC分期系统进行了比较。
新的AJCC黑色素瘤分期系统的变化反映了已发现的对预测生存很重要的新预后因素。这些因素包括原发肿瘤厚度（以毫米为单位的肿瘤深度比浸润水平更具预测性）和溃疡、转移淋巴结数量、基于前哨淋巴结活检技术或选择性淋巴结清扫的微转移疾病、远处转移疾病的部位以及血清乳酸脱氢酶水平。
已进行了重大修订以形成新的AJCC黑色素瘤分期系统，该系统将于2002年正式启用。该系统将提供有关患者预后的更准确和精确的信息。需要进行验证研究以证实该修订分期系统的准确性。
