Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system

A. C. Buzaid, M. I. Ross, Charles M. Balch, S. J. Soong, W. H. McCarthy, L. Tinoco, P. Mansfield, J. E. Lee, A. Bedikian, O. Eton, C. Plager, N. Papadopoulos, S. S. Legha, R. S. Benjamin

Research output: Contribution to journalArticle

Abstract

Purpose: 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. Methods: 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. Results: 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 ≤ 1 mm, but the absolute 10-year survival differences were small and inconsistent (level 8, 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1039-1051
Number of pages13
JournalJournal of Clinical Oncology
Volume15
Issue number3
StatePublished - Mar 1997
Externally publishedYes

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Neoplasm Staging
Melanoma
Skin
Neoplasm Metastasis
Neoplasms
Recurrence
Kaplan-Meier Estimate
Databases
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. / Buzaid, A. C.; Ross, M. I.; Balch, Charles M.; Soong, S. J.; McCarthy, W. H.; Tinoco, L.; Mansfield, P.; Lee, J. E.; Bedikian, A.; Eton, O.; Plager, C.; Papadopoulos, N.; Legha, S. S.; Benjamin, R. S.

In: Journal of Clinical Oncology, Vol. 15, No. 3, 03.1997, p. 1039-1051.

Research output: Contribution to journalArticle

Buzaid, AC, Ross, MI, Balch, CM, Soong, SJ, McCarthy, WH, Tinoco, L, Mansfield, P, Lee, JE, Bedikian, A, Eton, O, Plager, C, Papadopoulos, N, Legha, SS & Benjamin, RS 1997, 'Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system', Journal of Clinical Oncology, vol. 15, no. 3, pp. 1039-1051.
Buzaid, A. C. ; Ross, M. I. ; Balch, Charles M. ; Soong, S. J. ; McCarthy, W. H. ; Tinoco, L. ; Mansfield, P. ; Lee, J. E. ; Bedikian, A. ; Eton, O. ; Plager, C. ; Papadopoulos, N. ; Legha, S. S. ; Benjamin, R. S. / Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. In: Journal of Clinical Oncology. 1997 ; Vol. 15, No. 3. pp. 1039-1051.
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AU - Buzaid, A. C.

AU - Ross, M. I.

AU - Balch, Charles M.

AU - Soong, S. J.

AU - McCarthy, W. H.

AU - Tinoco, L.

AU - Mansfield, P.

AU - Lee, J. E.

AU - Bedikian, A.

AU - Eton, O.

AU - Plager, C.

AU - Papadopoulos, N.

AU - Legha, S. S.

AU - Benjamin, R. S.

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N2 - Purpose: 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. Methods: 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. Results: 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 ≤ 1 mm, but the absolute 10-year survival differences were small and inconsistent (level 8, 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. Conclusion: 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.

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