Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands.
Eur J Cancer. 2018 Mar;92:100-107. doi: 10.1016/j.ejca.2017.10.031. Epub 2017 Dec 5.
The 8th American Joint Committee on Cancer (AJCC) staging edition includes revisions regarding pT1 melanomas. We aimed to evaluate the expected impact of this edition on staging and survival in the Dutch pT1 melanoma population.
In total, 32,935 pT1 melanoma patients, whose data were retrieved from the Netherlands Cancer Registry between 2003 and 2015, were included in the study. Patients were stratified by the 6th AJCC edition (cohort 1: 2003-2009) and 7th edition (cohort 2: 2010-2015) and all reclassified according to the 8th edition. Stage migration, sentinel lymph node biopsy (SLNB) positivity rates and relative survival were analysed. Agreement between staging systems was calculated by Cohen's kappa coefficient.
In cohort 2, restaging according to the 8th edition led to an increase of 7% in the total number of patients staged pT1b. The kappa score for agreement between the 6th and 8th edition was 0.15 and 0.25 for agreement between 7th and 8th edition. Restaging according to the 8th edition resulted in a higher SLNB positivity rate for pT1b patients than pT1a patients (8% versus 5%, p = 0.08). Relative survival curves were predominantly similar between the staging editions.
Implementation of the 8th AJCC staging edition will presumably not have major impact on the total number of Dutch pT1b patients. Consequently, the number of patients eligible for SLNB would roughly remain similar. In terms of SLNB positivity, the selection of high-risk pT1 melanoma patients is likely to improve. In addition, the 8th edition criteria for pT1 melanoma seem more workable for pathologists.
第 8 版美国癌症联合委员会（AJCC）分期系统包括对 pT1 黑色素瘤的修订。我们旨在评估该版本对荷兰 pT1 黑色素瘤人群分期和生存的预期影响。
共纳入 32935 例 pT1 黑色素瘤患者，数据来源于 2003 年至 2015 年荷兰癌症登记处。患者根据第 6 版 AJCC 分期（队列 1：2003-2009 年）和第 7 版（队列 2：2010-2015 年）进行分层，并根据第 8 版进行重新分类。分析了分期迁移、前哨淋巴结活检（SLNB）阳性率和相对生存率。通过 Cohen's kappa 系数计算分期系统之间的一致性。
在队列 2 中，根据第 8 版重新分期导致 pT1b 分期患者总数增加了 7%。第 6 版和第 8 版之间的 kappa 评分分别为 0.15，第 7 版和第 8 版之间的 kappa 评分为 0.25。根据第 8 版重新分期导致 pT1b 患者的 SLNB 阳性率高于 pT1a 患者（8%比 5%，p=0.08）。分期版本之间的相对生存率曲线主要相似。
第 8 版 AJCC 分期系统的实施可能不会对荷兰 pT1b 患者的总数产生重大影响。因此，符合 SLNB 条件的患者数量大致保持不变。在 SLNB 阳性方面，高风险 pT1 黑色素瘤患者的选择可能会得到改善。此外，第 8 版 pT1 黑色素瘤的标准对病理学家来说似乎更可行。
