Department of Surgery, Oncology and Dermatology, Johns Hopkins Medical Institutions, 600 N. Wolfe St, Osler 624, Baltimore, MD, 21287, USA.
J Clin Oncol. 2009 Dec 20;27(36):6199-206. doi: 10.1200/JCO.2009.23.4799. Epub 2009 Nov 16.
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.
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.
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.
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.
基于美国癌症联合委员会（AJCC）黑色素瘤分期数据库中扩大的数据，修订皮肤黑色素瘤分期系统。
通过对 30946 例 I、II 和 III 期黑色素瘤患者和 7972 例 IV 期黑色素瘤患者的多因素分析，提出黑色素瘤分期建议，以修订和澄清 TNM 分类和分期分组标准。
研究结果和新定义包括以下内容：（1）在局限性黑色素瘤患者中，肿瘤厚度、有丝分裂率（组织学上定义为每平方毫米有丝分裂）和溃疡是最重要的预后因素。（2）有丝分裂率取代浸润程度作为定义 T1b 黑色素瘤的主要标准。（3）在 3307 例区域转移患者中，定义 N 分期的因素包括转移淋巴结的数量、肿瘤负荷和原发性黑色素瘤的溃疡。（4）为分期目的，所有有显微镜下淋巴结转移的患者，无论肿瘤负荷程度如何，均归类为 III 期。特别包括免疫组化检测到的微转移。（5）根据对远处转移患者的多因素分析，定义 M 分期的两个主要因素仍然是远处转移部位（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。
通过循证方法，对 AJCC 黑色素瘤分期系统进行了修订，反映了我们对该疾病认识的提高。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。
