Buethe D, Warner C, Miedler J, Cockerell C J
Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9191, USA.
J Skin Cancer. 2011;2011:156391. doi: 10.1155/2011/156391. Epub 2010 Nov 22.
The 7th edition of the AJCC Cancer Staging Manual represents a dramatic shift in the way that cutaneous squamous cell carcinoma (cSCC) is staged, in that it is first attempt to incorporate evidence-based medicine into the staging guidelines for cSCC. In our opinion, the changes made to the seventh edition represent a significant improvement over previous editions and will ultimately lead to improved patient stratification, more accurate prognostic data, and a better framework to guide clinical decision making. However, there are a number of issues within the latest guidelines that require clarification or are impractical for clinical practice. The purpose of this paper is to highlight the key changes to the 6th edition staging manual as they pertain to cSCC, to point out impractical component of the 7th edition and/or aspects that require further clarification, and to make recommendations that address any current shortcomings to improve subsequent editions. Specific focus will be given to the inclusion of separate guidelines for cSCC and Merkel cell carcinoma (MCC), the incorporation of high-risk factors as modifiers of T stage, the addition of new guidelines for advanced T stage, and the changes in stratification of lymph node status. This paper is modified from a more comprehensive treatment of the staging of nonmelanoma skin cancer by Warner and Cockerell entitled "The new 7th edition American joint committee on cancer staging of cutaneous nonmelanoma skin cancer: a critical review," in the American Journal of Clinical Dermatology (paper accepted, pending publication).
美国癌症联合委员会（AJCC）《癌症分期手册》第7版在皮肤鳞状细胞癌（cSCC）的分期方式上有了显著转变，这是首次尝试将循证医学纳入cSCC的分期指南。我们认为，第7版所做的更改相较于之前版本有显著改进，最终将带来更优的患者分层、更准确的预后数据以及指导临床决策的更好框架。然而，最新指南中存在一些问题需要阐明，或者在临床实践中不切实际。本文的目的是突出第6版分期手册中与cSCC相关的关键变化，指出第7版中不切实际的部分和/或需要进一步阐明的方面，并提出解决当前缺陷以改进后续版本的建议。将特别关注针对cSCC和默克尔细胞癌（MCC）的单独指南的纳入、将高危因素纳入作为T分期的修正因素、新增晚期T分期指南以及淋巴结状态分层的变化。本文改编自Warner和Cockerell对非黑色素瘤皮肤癌分期更全面的论述，题为《美国癌症联合委员会皮肤非黑色素瘤皮肤癌分期新第7版：批判性综述》，发表于《美国临床皮肤病学杂志》（已接受发表，待刊出）。
