Pritesh S. Karia, George F. Murphy, Abrar A. Qureshi, and Chrysalyne D. Schmults, Brigham and Women's Hospital, Harvard Medical School; David P. Harrington, Harvard School of Public Health, Boston, MA; and Anokhi Jambusaria-Pahlajani, Mayo Clinic, Jacksonville, FL.
J Clin Oncol. 2014 Feb 1;32(4):327-34. doi: 10.1200/JCO.2012.48.5326. Epub 2013 Dec 23.
To compare American Joint Committee on Cancer (AJCC), International Union Against Cancer (UICC), and Brigham and Women's Hospital (BWH) tumor (T) staging systems for cutaneous squamous cell carcinoma and validate BWH staging against prior data.
Primary tumors diagnosed from 2000 to 2009 at BWH (n = 1,818) were analyzed. Poor outcomes (local recurrence [LR], nodal metastasis [NM], and disease-specific death [DSD]) were analyzed by T stage with regard to each staging system's distinctiveness (outcome differences between stages), homogeneity (outcome similarity within stages), and monotonicity (outcome worsening with increasing stage).
AJCC and UICC T3 and T4 were indistinct with overlapping 95% CIs for 10-year cumulative incidences of poor outcomes, but all four BWH stages were distinct. AJCC and UICC high-stage tumors (T3/T4) were rare at 0.3% and 3% of the cohort, respectively. Most poor outcomes occurred in low stages (T1/T2; AJCC: 86% [95% CI, 77% to 91%]; UICC: 70% [61% to 79%]) resulting in heterogeneous outcomes in T1/T2. Conversely, in BWH staging, only 5% of tumors were high stage (T2b/T3), but they accounted for 60% (95% CI, 50% to 69%) of poor outcomes (70% of NMs and 83% of DSDs) indicating superior homogeneity and monotonicity as previously defined. Cumulative incidences of poor outcomes were low for BWH low-stage (T1/T2a) tumors (LR, 1.4% [95% CI, 1% to 2%]; NM, 0.6% [95% CI, 0% to 1%]; DSD, 0.2% [95% CI, 0% to 0.5%]) and higher for high-stage (T2b/T3) tumors (LR, 24% [95% CI, 16% to 34%]; NM, 24% [95% CI, 16% to 34%]; and DSD, 16% [95% CI, 10% to 25%], which validated an earlier study of an alternative staging system.
BWH staging offers improved distinctiveness, homogeneity, and monotonicity over AJCC and UICC staging. Population-based validation is needed. BWH T2b/T3 tumors define a high-risk group requiring further study for optimal management.
比较美国癌症联合委员会（AJCC）、国际抗癌联盟（UICC）和布莱根妇女医院（BWH）的皮肤鳞状细胞癌肿瘤（T）分期系统，并验证 BWH 分期与先前数据的一致性。
分析 2000 年至 2009 年在 BWH 诊断的原发性肿瘤（n=1818）。根据每个分期系统的独特性（分期之间的结果差异）、同质性（分期内的结果相似性）和单调性（随着分期的增加而结果恶化），对 T 分期进行不良结局（局部复发[LR]、淋巴结转移[NM]和疾病特异性死亡[DSD]）分析。
AJCC 和 UICC 的 T3 和 T4 不明显，10 年累积不良结局发生率的 95%置信区间重叠，但所有四个 BWH 分期都很明显。AJCC 和 UICC 的高分期肿瘤（T3/T4）分别占队列的 0.3%和 3%，非常罕见。大多数不良结局发生在低分期（T1/T2；AJCC：86%[95%CI，77%至 91%]；UICC：70%[61%至 79%]），导致 T1/T2 结果不一致。相反，在 BWH 分期中，只有 5%的肿瘤为高分期（T2b/T3），但它们占不良结局的 60%（95%CI，50%至 69%）（70%的 NM 和 83%的 DSD），表明先前定义的同质性和单调性更好。BWH 低分期（T1/T2a）肿瘤的不良结局累积发生率较低（LR，1.4%[95%CI，1%至 2%]；NM，0.6%[95%CI，0%至 1%]；DSD，0.2%[95%CI，0%至 0.5%]），而高分期（T2b/T3）肿瘤的不良结局累积发生率较高（LR，24%[95%CI，16%至 34%]；NM，24%[95%CI，16%至 34%]；和 DSD，16%[95%CI，10%至 25%]），这验证了先前对替代分期系统的研究。
BWH 分期在独特性、同质性和单调性方面优于 AJCC 和 UICC 分期。需要进行基于人群的验证。BWH T2b/T3 肿瘤定义了一个高危人群，需要进一步研究以实现最佳管理。
