Hu Di, Liu Zeming, Chen Sichao, Huang Yihui, Zeng Wen, Wei Wei, Zhang Chao, Zhou Ling, Chen Danyang, Wu Yiping, Guo Liang
Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Plastic Surgery and Cosmetic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Apr 29;12:738298. doi: 10.3389/fonc.2022.738298. eCollection 2022.
The clinical TNM staging system does not differ between the 7 and 8 editions of the American Joint Committee on Cancer (AJCC) staging manual. A more practical TNM staging system for patients with stage I-III cutaneous melanoma are needed.
Data were accessed from the Surveillance, Epidemiology, and End Results (SEER) open database. We divided the patients into 32 groups based on the T and N categories. The Kaplan-Meier survival curves and treatment guidelines were used to proposed a new TNM staging system. Cox proportional hazards model and 1000-person-years were used to verify accuracy.
This retrospective study included 68 861 patients from 2010 to 2015. The new proposed staging system was as follows: stage IA, T1aN0M0; stage IB, T1b/T2aN0M0; stage IIA, T3-4aN0M0 and T2bN0M0; stage IIB, T1-4aN1-2M0 and T3-4bN0M0; and stage III, T1-4aN3M0 and T1-4bN1-3M0. Hazard ratios for the new stages IB, IIA, IIB, and III, with stage IA as reference, were 4.311 (95% confidence interval [CI]: 3.217-5.778), 8.993 (95% CI: 6.637-12.186), 13.179 (95% CI: 9.435-18.407), and 20.693 (95% CI: 13.655-31.356), respectively (all p-values < 0.001). Cancer-specific mortality rates per 1000-person-years were 0.812 (95% CI: 0.674-0.978), 6.612 (95% CI: 5.936-7.364), 22.228 (95% CI: 20.128-24.547), 50.863 (95% CI: 47.472-54.496) and 120.318 (95% CI: 112.596-128.570) for stages IA, IB, IIA, IIB and III, respectively.
We developed a more practical and prognosis-relevant staging system than that of the 8 edition AJCC manual for patients with stage I-III cutaneous melanoma. Treatments using this new model would improve the quality of life and survival rates of patients with melanoma.
美国癌症联合委员会（AJCC）分期手册第7版和第8版的临床TNM分期系统并无差异。对于I - III期皮肤黑色素瘤患者，需要一个更实用的TNM分期系统。
数据来自监测、流行病学和最终结果（SEER）开放数据库。我们根据T和N分类将患者分为32组。使用Kaplan - Meier生存曲线和治疗指南来提出一个新的TNM分期系统。采用Cox比例风险模型和1000人年数据来验证准确性。
这项回顾性研究纳入了2010年至2015年的68861例患者。新提出的分期系统如下：IA期，T1aN0M0；IB期，T1b/T2aN0M0；IIA期，T3 - 4aN0M0和T2bN0M0；IIB期，T1 - 4aN1 - 2M0和T3 - 4bN0M0；III期，T1 - 4aN3M0和T1 - 4bN1 - 3M0。以IA期为参照，新的IB期、IIA期、IIB期和III期的风险比分别为4.311（95%置信区间[CI]：3.217 - 5.778）、8.993（95%CI：6.637 - 12.186）、13.179（95%CI：9.435 - 18.407）和20.693（95%CI：13.655 - 31.356）（所有p值<0.001）。IA期、IB期、IIA期、IIB期和III期每1000人年的癌症特异性死亡率分别为0.812（95%CI：0.674 - 0.978）、6.612（95%CI：5.936 - 7.364）、22.228（95%CI：20.128 - 24.547）、50.863（95%CI：47.472 - 54.496）和120.318（95%CI：112.596 - 128.570）。
我们为I - III期皮肤黑色素瘤患者开发了一个比AJCC手册第8版更实用且与预后相关的分期系统。使用这个新模型进行治疗将提高黑色素瘤患者的生活质量和生存率。
