External validation of the American Joint Committee on Cancer 8th edition melanoma staging system: who needs adjuvant treatment?

External validation of the American Joint Committee on Cancer 8th edition melanoma staging system: who needs adjuvant treatment?

Publication date: Oct 22, 2019

Now effective adjuvant therapy has arrived in melanoma, accurate staging and patient selection to optimize its risk/benefit ratio is crucial. The American Joint Committee on Cancer staging system is the most widely used and validated melanoma staging system, which recently released its 8th edition. We aimed to externally validate the prognostic and discriminatory ability for survival of the 8th edition compared to the 7th edition and evaluate prognostic factors. Prospective database of stage III melanoma (2000-2016). Prognostic factors for melanoma-specific survival and distant metastasis-free survival were analyzed. Survival differentiation of the 7th and 8th edition was assessed with log-rank tests and Cox proportional hazards models. Discriminatory ability was compared using the receiver operating characteristic and Akaike’s Information Criterion. Six hundred forty patients were included (median follow-up 59 months). Median melanoma-specific survival was 138 months, distant metastasis-free survival 96 months. Age, Breslow thickness, ulceration of the primary tumor and number of positive lymph nodes (N) were independent prognostic parameters for distant metastasis-free survival and melanoma-specific survival. The 8th edition performed slightly better than the 7th edition in terms of survival discrimination but showed slightly worse distant metastasis-free survival and melanoma-specific survival differentiation between stage IIIA and IIIB. Sentinel node (SN) metastasis size cutoff of 1 mm differentiated survival in both 7th and 8th edition stage IIIA, showing excellent distant metastasis-free survival and melanoma-specific survival for patients with a SN metastasis size

Madu, M.F., , Franke, Van de Wiel, B.A., Klop, W.M.C., J’o’zwiak, K., van Houdt, W.J., Wouters, M.W.J.M., and van Akkooi, A.C.J. External validation of the American Joint Committee on Cancer 8th edition melanoma staging system: who needs adjuvant treatment? 24682. 2019 Melanoma Res.

Concepts Keywords
Adjuvant Medicine
Adjuvant Therapy Clinical medicine
Discrimination Cancer
Lymph Nodes Melanoma
Median RTT
Melanoma Breslow’s depth
Metastasis Metastasis
Primary Tumor Cancer staging
Proportional Hazards Models Adjuvant therapy
Receiver Operating Characteristic TNM staging system
Ulceration

Semantics

Type Source Name
disease MESH Cancer
disease DOID Cancer
disease MESH melanoma
disease DOID melanoma
pathway BSID Melanoma
disease MESH metastasis
gene UNIPROT TNFRSF11A
gene UNIPROT CPOX
gene UNIPROT RENBP
drug DRUGBANK Tropicamide

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