Stage III Melanoma: A Proposed Staging Model That Outperforms the American Joint Committee on Cancer Eighth Edition Staging System.

IF 4.5 1区 医学 Q1 PATHOLOGY American Journal of Surgical Pathology Pub Date : 2024-10-01 Epub Date: 2024-06-20 DOI:10.1097/PAS.0000000000002269
Alexandra Balaban, Kasey J McCollum, Rami N Al-Rohil
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Abstract

National Comprehensive Cancer Network guidelines state that clinical stage III melanoma patients may undergo ultrasound surveillance of the nodal basin in lieu of complete lymph node dissection (CLND). This has led to an inability to accurately classify patients according to the American Joint Committee on Cancer (AJCC) eighth edition staging system because it uses the total number of positive lymph nodes from the CLND to assign a pathologic N stage. We propose a new model for clinical stage III melanoma patients that does not rely on the total number of positive lymph nodes. Instead, it uses Breslow depth, ulceration status, sentinel lymph node metastasis size, and extracapsular extension to stratify patients into groups 1 to 4. We compared our model's ability to predict melanoma-specific survival (MSS), distant metastasis-free survival (DMFS) and locoregional recurrence, and distant metastasis-free survival (DMFS-LRFS) to the current AJCC system with and without CLND-data using a Cox proportional hazards model and Akaike Information Criteria weights. Although not reaching our predetermined level of statistical significance of 95%, our model was 5 times more likely to better predict MSS compared with the AJCC model with CLND. In addition, our model was significantly better than the AJCC model without CLND in predicting MSS. Our model performed significantly better than the AJCC model in predicting DMFS and DMFS-LRFS regardless of whether data from CLND were included.

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黑色素瘤 III 期:超越美国癌症联合委员会第八版分期系统的拟议分期模型。
美国国家综合癌症网络指南规定,临床 III 期黑色素瘤患者可接受结节盆地超声监测,以取代完全淋巴结清扫术(CLND)。这导致无法根据美国癌症联合委员会(AJCC)第八版分期系统对患者进行准确分期,因为该系统使用完整淋巴结清扫的阳性淋巴结总数来划分病理 N 期。我们为临床 III 期黑色素瘤患者提出了一种不依赖于阳性淋巴结总数的新模式。我们使用 Cox 比例危险度模型和 Akaike 信息标准权重,比较了我们的模型预测黑色素瘤特异性生存(MSS)、无远处转移生存(DMFS)、局部区域复发和无远处转移生存(DMFS-LRFS)的能力,以及有 CLND 数据和无 CLND 数据的现行 AJCC 系统。虽然没有达到我们预定的 95% 统计显著性水平,但与有 CLND 数据的 AJCC 模型相比,我们的模型预测 MSS 的可能性高出 5 倍。此外,在预测 MSS 方面,我们的模型明显优于无 CLND 的 AJCC 模型。在预测 DMFS 和 DMFS-LRFS 方面,无论是否纳入 CLND 数据,我们的模型都明显优于 AJCC 模型。
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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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