Buzaid A C, Ross M I, Balch C M, Soong S, McCarthy W H, Tinoco L, Mansfield P, Lee J E, Bedikian A, Eton O, Plager C, Papadopoulos N, Legha S S, Benjamin R S
Department of Melanoma/Sarcoma and Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
J Clin Oncol. 1997 Mar;15(3):1039-51. doi: 10.1200/JCO.1997.15.3.1039.
To critically review the accuracy of the current American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma and propose a more useful staging system.
Retrospective evaluation of the published data as well as a reanalysis of the University of Alabama and Sydney Melanoma Unit (UAB/SMU) data bases (n = 4,568) for patients with primary melanoma was performed to examine specifically the impact of level of invasion and ulceration on the prognostic value of tumor thickness. In addition, an overlay graphic technique was used to compare the Kaplan-Meier survival curves of patients with local recurrences, satellites, in-transit metastases, and nodal metastases reported in the literature.
Tumor thickness and ulceration remained the most powerful prognostic indicators in patients with stage I and II disease. Level of invasion provided statistically significant prognostic information only in the subgroup of patients with tumor thickness < or = 1 mm, but the absolute 10-year survival differences were small and inconsistent (level II, 95%; level III, 85%; level IV, 89%). The best statistical fit for tumor thickness cutoffs was at 1 versus 2 versus 4 mm. The overlay graphic technique showed that patients who developed satellite lesions or local recurrence had prognoses similar to those of patients with stage III disease. The most important prognostic factor for patients with nodal metastases was number of involved nodes rather than size.
Our analysis showed that the current AJCC staging system has many inaccuracies that should be modified to conform to published data. On the basis of our analysis and review of the literature, we propose a new and more accurate staging system.
严格评估当前美国癌症联合委员会（AJCC）皮肤黑色素瘤分期系统的准确性，并提出一个更实用的分期系统。
对已发表的数据进行回顾性评估，并对阿拉巴马大学和悉尼黑色素瘤研究组（UAB/SMU）的数据库（n = 4568例）进行重新分析，以专门研究浸润深度和溃疡对肿瘤厚度预后价值的影响。此外，采用叠加图形技术比较文献中报道的局部复发、卫星灶、移行转移和区域淋巴结转移患者的Kaplan-Meier生存曲线。
肿瘤厚度和溃疡仍然是Ⅰ期和Ⅱ期患者最有力的预后指标。浸润深度仅在肿瘤厚度≤1mm的患者亚组中提供了具有统计学意义的预后信息，但绝对的10年生存差异较小且不一致（Ⅱ级，95%；Ⅲ级，85%；Ⅳ级，89%）。肿瘤厚度临界值的最佳统计拟合为1mm对2mm对4mm。叠加图形技术显示，出现卫星灶或局部复发患者的预后与Ⅲ期患者相似。区域淋巴结转移患者最重要的预后因素是受累淋巴结的数量而非大小。
我们的分析表明，当前的AJCC分期系统存在许多不准确之处，应进行修改以符合已发表的数据。基于我们的分析和文献综述，我们提出了一个新的、更准确的分期系统。
