Gershenwald Jeffrey E, Scolyer Richard A, Hess Kenneth R, Sondak Vernon K, Long Georgina V, Ross Merrick I, Lazar Alexander J, Faries Mark B, Kirkwood John M, McArthur Grant A, Haydu Lauren E, Eggermont Alexander M M, Flaherty Keith T, Balch Charles M, Thompson John F
Professor of Surgery and Cancer Biology, Department of Surgical Oncology; Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX.
Conjoint Medical Director, Melanoma Institute Australia; Clinical Professor, The University of Sydney, Sydney, New South Wales, Australia.
CA Cancer J Clin. 2017 Nov;67(6):472-492. doi: 10.3322/caac.21409. Epub 2017 Oct 13.
Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors "microscopic" and "macroscopic" for regional node metastasis are redefined as "clinically occult" and "clinically apparent"; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA-IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472-492. © 2017 American Cancer Society.
回答问题并获得CME/CNE 为更新美国癌症联合委员会（AJCC）的黑色素瘤分期系统，建立了一个大型数据库，纳入了自1998年以来全球10个中心诊断为I、II和III期黑色素瘤的46,000多名患者。基于对这个新数据库、现有的第七版AJCC IV期数据库以及当代临床试验数据的分析，AJCC黑色素瘤专家小组对肿瘤、淋巴结、转移（TNM）分类和分期分组标准进行了多项重要更改。第八版AJCC癌症分期手册中的主要更改包括：1）肿瘤厚度测量记录精确到最接近的0.1mm，而非0.01mm；2）T1a和T1b的定义修订（T1a，厚度<0.8mm且无溃疡；T1b，厚度0.8 - 1.0mm伴或不伴溃疡或厚度<0.8mm且有溃疡），有丝分裂率不再作为T分类标准；3）病理（而非临床）IA期修订为包括T1b N0 M0（原病理IB期）；4）区域淋巴结转移的N分类描述词“显微镜下”和“肉眼可见”重新定义为“临床隐匿性”和“临床显性”；5）预后III期分组基于N分类标准和T分类标准（即原发肿瘤厚度和溃疡情况），亚组从3个增加到4个（IIIA - IIID期）；6）N亚类定义修订，微卫星、卫星灶或皮下转移灶的存在现根据受累区域淋巴结的肿瘤数量归类为N1c、N2c或N3c（如有）；7）为每个M1亚类指定添加乳酸脱氢酶（LDH）水平描述词（LDH升高不再将分期提升至M1c）；8）新增M1d用于中枢神经系统转移。AJCC黑色素瘤分期系统的这一循证修订将指导患者治疗，提供更好的预后估计，并优化进入临床试验患者的分层。《CA：临床医师癌症杂志》2017年；67：472 - 492。©2017美国癌症协会
