Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Newtown, NSW, Australia.
Ann Surg Oncol. 2012 Dec;19(13):4252-8. doi: 10.1245/s10434-012-2504-2. Epub 2012 Jul 18.
The American Joint Committee on Cancer (AJCC) substantially changed the staging of cutaneous squamous cell carcinoma (cSCC) in the 7th edition of its staging manual. We aim to compare the 7th edition AJCC staging of nodal metastases from cSCC with the N1S3 staging system.
Analysis of 603 patients from two prospective cancer center databases was performed. Multivariable analysis was performed using a Cox proportional hazards competing risk model adjusting for the effect of immunosuppression, treating institution, adjuvant radiotherapy, nodal margins, and extracapsular spread. Criteria used for comparing staging systems were distribution of patients, stratification of patients according to risk of death from cSCC, and model performance.
The N1S3 staging system functioned well in terms of distribution and stratification of patients. The distribution of patients within the AJCC staging system was problematic with three groups (N2a, N2c, and N3) containing less than 10 % of patients without any prognostic relevance. Stratification of patients within the AJCC staging system was poor in terms of monotonicity (N2c) and distinctiveness (N2a). The performance of the AJCC and N1S3 staging systems was similar despite the AJCC staging being more complex.
The N1S3 staging system for cSCC is preferred on the grounds of better distribution, stratification, and parsimony.
美国癌症联合委员会（AJCC）在其第 7 版分期手册中对皮肤鳞状细胞癌（cSCC）的分期进行了重大修改。我们旨在比较第 7 版 AJCC 对 cSCC 淋巴结转移的分期与 N1S3 分期系统。
对来自两个前瞻性癌症中心数据库的 603 名患者进行了分析。使用 Cox 比例风险竞争风险模型进行多变量分析，该模型调整了免疫抑制、治疗机构、辅助放疗、淋巴结边缘和包膜外扩散的影响。比较分期系统的标准是患者的分布、根据 cSCC 死亡风险对患者进行分层以及模型性能。
N1S3 分期系统在患者的分布和分层方面表现良好。AJCC 分期系统中的患者分布存在问题，三个组（N2a、N2c 和 N3）中各包含不到 10%的患者，但没有任何预后意义。在 AJCC 分期系统中，分层方面存在单调性（N2c）和独特性（N2a）较差的问题。尽管 AJCC 分期更为复杂，但 AJCC 和 N1S3 分期系统的性能相似。
N1S3 分期系统更优，因为它具有更好的分布、分层和简约性。
