التفاصيل البيبلوغرافية
| العنوان: |
Melanoma Prognosis: Accuracy of the American Joint Committee on Cancer Staging Manual Eighth Edition. |
| المؤلفون: |
Bajaj, Shirin, Donnelly, Douglas, Call, Melissa, Johannet, Paul, Moran, Una, Polsky, David, Shapiro, Richard, Berman, Russell, Pavlick, Anna, Weber, Jeffrey, Zhong, Judy, Osman, Iman |
| المصدر: |
JNCI: Journal of the National Cancer Institute; Sep2020, Vol. 112 Issue 9, p921-928, 8p |
| مصطلحات موضوعية: |
TUMOR classification, MELANOMA, LOG-rank test, PROGNOSIS, DISEASE progression, MELANOMA diagnosis, MELANOMA treatment, RESEARCH, RESEARCH evaluation, PREDICTIVE tests, RESEARCH methodology, METASTASIS, MEDICAL cooperation, EVALUATION research, MEDICAL protocols, SKIN tumors, COMPARATIVE studies, RESEARCH funding, ONCOLOGY, MEDICAL societies, LONGITUDINAL method, STANDARDS |
| مصطلحات جغرافية: |
UNITED States |
| مستخلص: |
Background: The American Joint Committee on Cancer (AJCC) maintains that the eighth edition of its Staging Manual (AJCC8) has improved accuracy compared with the seventh (AJCC7). However, there are concerns that implementation may disrupt analysis of active clinical trials for stage III patients. We used an independent cohort of melanoma patients to test the extent to which AJCC8 has improved prognostic accuracy compared with AJCC7.Methods: We analyzed a cohort of 1315 prospectively enrolled patients. We assessed primary tumor and nodal classification of stage I-III patients using AJCC7 and AJCC8 to assign disease stages at diagnosis. We compared recurrence-free (RFS) and overall survival (OS) using Kaplan-Meier curves and log-rank tests. We then compared concordance indices of discriminatory prognostic ability and area under the curve of 5-year survival to predict RFS and OS. All statistical tests were two-sided.Results: Stage IIC patients continued to have worse outcomes than stage IIIA patients, with a 5-year RFS of 26.5% (95% confidence interval [CI] = 12.8% to 55.1%) vs 56.0% (95% CI = 37.0% to 84.7%) by AJCC8 (P = .002). For stage I, removing mitotic index as a T classification factor decreased its prognostic value, although not statistically significantly (RFS concordance index [C-index] = 0.63, 95% CI = 0.56 to 0.69; to 0.56, 95% CI = 0.49 to 0.63, P = .07; OS C-index = 0.48, 95% CI = 0.38 to 0.58; to 0.48, 95% CI = 0.41 to 0.56, P = .90). For stage II, prognostication remained constant (RFS C-index = 0.65, 95% CI = 0.57 to 0.72; OS C-index = 0.61, 95% CI = 0.50 to 0.72), and for stage III, AJCC8 yielded statistically significantly enhanced prognostication for RFS (C-index = 0.65, 95% CI = 0.60 to 0.70; to 0.70, 95% CI = 0.66 to 0.75, P = .01).Conclusions: Compared with AJCC7, we demonstrate that AJCC8 enables more accurate prognosis for patients with stage III melanoma. Restaging a large cohort of patients can enhance the analysis of active clinical trials. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
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