Balch Charles M, Buzaid Antonio C, Soong Seng-Jaw, Atkins Michael B, Cascinelli Natale, Coit Daniel G, Fleming Irvin D, Gershenwald Jeffrey E, Houghton Alan, Kirkwood John M, McMasters Kelly M, Mihm Martin F, Morton Donald L, Reintgen Douglas S, Ross Merrick I, Sober Arthur, Thompson John A, Thompson John F
Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Semin Surg Oncol. 2003;21(1):43-52. doi: 10.1002/ssu.10020.
The American Joint Committee on Cancer (AJCC) implemented major revisions of the melanoma TNM and stage grouping criteria in the recently published 6th edition of the Staging Manual. The new staging system better reflects independent prognostic factors that are used in clinical trials and in reporting the outcomes of various melanoma treatment modalities. Major revisions include: 1) melanoma thickness and ulceration but not level of invasion to be used in the T classification, 2) the number of metastatic lymph nodes rather than their gross dimensions and the delineation of microscopic vs. macroscopic nodal metastases to be used in the N classification, 3) the site of distant metastases and the presence of elevated serum lactic dehydrogenase (LDH) to be used in the M classification, 4) an upstaging of all patients with Stage I, II, and III disease when a primary melanoma is ulcerated, 5) a merging of satellite metastases around a primary melanoma and in transit metastases into a single staging entity that is grouped into Stage III disease, and 6) a new convention for defining clinical and pathological staging so as to take into account the new staging information gained from intraoperative lymphatic mapping and sentinel node biopsy.
美国癌症联合委员会（AJCC）在最近出版的第6版《分期手册》中对黑色素瘤TNM分期和分组标准进行了重大修订。新的分期系统能更好地反映在临床试验及报告各种黑色素瘤治疗方式结果时所使用的独立预后因素。主要修订内容包括：1）T分类采用黑色素瘤厚度和溃疡情况而非浸润深度；2）N分类采用转移淋巴结数量而非其大体尺寸，并区分微小与大体淋巴结转移；3）M分类采用远处转移部位及血清乳酸脱氢酶（LDH）升高情况；4）原发性黑色素瘤出现溃疡时，所有I、II和III期患者分期上调；5）将原发性黑色素瘤周围的卫星转移灶和移行转移灶合并为一个单一分期实体，归入III期疾病；6）定义临床和病理分期的新惯例，以考虑从术中淋巴管造影和前哨淋巴结活检获得的新分期信息。
