Fleming I D, Phillips J L, Menck H R, Murphy G P, Winchester D P
American Joint Committee on Cancer, University of Tennessee Center for Health Sciences, Memphis, USA.
Cancer. 1997 Dec 15;80(12):2305-10.
American Joint Committee on Cancer (AJCC) staging procedures were first published in 1977. Since 1991 the Commission on Cancer (COC) has required AJCC staging of all nonpediatric cancers. The National Cancer Data Base (NCDB) encouraged recording of AJCC staging through analyses of selected aspects of staging completeness. We reviewed the trend toward the adoption of routine AJCC staging by hospitals for the 5-year period 1990-1994.
NCDB reports for nearly 2 million stageable cancers diagnosed from 1990 through 1994 were examined with emphasis on the hospital cancer program environment. Staging was complete if the hospital submitted stage codes for > or =90% of stageable cases or absent if stage codes were submitted for <5%. Hospitals were classified by ownership and type of cancer program. Regional staging practices also were reviewed.
Overall staging increased from 78% to 88%, with increases for every site except carcinomas of the skin, cancers of the extrahepatic bile ducts and urethra, melanoma of the eyelid, and retinoblastoma The percent of hospitals staging completely increased from 49% to 61%, and the percent not routinely staging decreased from 6% to 3%. Complete staging increased in all hospital categories except For-Profit. The trend toward complete staging was uneven among states and regions.
Hospital staging policies were affected by activities of the AJCC, COC, NCDB, clinical protocol procedures, and state policies. The varied completeness of staging at the hospital level by state, region, and type of hospital indicates that the adoption of routine staging is ongoing.
美国癌症联合委员会（AJCC）分期程序于1977年首次发布。自1991年以来，癌症委员会（COC）要求对所有非儿科癌症进行AJCC分期。国家癌症数据库（NCDB）通过对分期完整性的选定方面进行分析，鼓励记录AJCC分期。我们回顾了1990 - 1994年这5年期间医院采用常规AJCC分期的趋势。
检查了1990年至1994年诊断出的近200万例可分期癌症的NCDB报告，重点关注医院癌症项目环境。如果医院为≥90%的可分期病例提交了分期代码，则分期完整；如果提交分期代码的病例<5%，则分期缺失。医院按所有权和癌症项目类型进行分类。还审查了区域分期实践。
总体分期从78%增加到88%，除皮肤癌、肝外胆管癌和尿道癌、眼睑黑色素瘤和视网膜母细胞瘤外，每个部位的分期均有所增加。完全分期的医院百分比从49%增加到61%，未进行常规分期的百分比从6%下降到3%。除营利性医院外，所有医院类别中的完全分期均有所增加。各州和各地区完全分期的趋势不均衡。
医院分期政策受到AJCC、COC、NCDB、临床诊疗规范程序和州政策活动的影响。按州、地区和医院类型划分的医院层面分期完整性的差异表明，常规分期的采用仍在进行中。
