Melanoma Prognosis: Accuracy of the American Joint Committee on Cancer Staging Manual Eighth Edition.
Adult
Aged
Female
Humans
Male
Medical Oncology
/ organization & administration
Melanoma
/ diagnosis
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
/ standards
Practice Guidelines as Topic
Predictive Value of Tests
Prognosis
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Skin Neoplasms
/ diagnosis
Societies, Medical
/ standards
United States
/ epidemiology
Journal
Journal of the National Cancer Institute
ISSN: 1460-2105
Titre abrégé: J Natl Cancer Inst
Pays: United States
ID NLM: 7503089
Informations de publication
Date de publication:
01 09 2020
01 09 2020
Historique:
received:
07
10
2019
revised:
11
11
2019
accepted:
20
11
2019
pubmed:
25
1
2020
medline:
29
4
2021
entrez:
25
1
2020
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31977051
pii: 5715587
doi: 10.1093/jnci/djaa008
pmc: PMC7492758
doi:
Types de publication
Comparative Study
Evaluation Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
921-928Subventions
Organisme : NCI NIH HHS
ID : P50 CA225450
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA016087
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Références
Eur J Cancer. 2018 Mar;92:100-107
pubmed: 29217356
Eur J Cancer. 2019 May;112:9-11
pubmed: 30884440
Eur J Cancer. 2016 Mar;56:45-53
pubmed: 26802530
Eur J Cancer. 2018 Mar;91:168-170
pubmed: 29224903
Clin Cancer Res. 2020 Mar 1;26(5):1126-1134
pubmed: 31636101
JAMA. 2017 Dec 12;318(22):2199-2210
pubmed: 29234806
Br J Dermatol. 2018 Dec;179(6):1422-1423
pubmed: 30187449
J Cutan Pathol. 2018 Aug;45(8):588-596
pubmed: 29717800
CA Cancer J Clin. 2017 Nov;67(6):472-492
pubmed: 29028110
Lancet Oncol. 2018 Dec;19(12):e720-e725
pubmed: 30507438
Am J Surg Pathol. 2003 Dec;27(12):1571-6
pubmed: 14657718
IEEE Trans Med Imaging. 2018 Mar 28;:
pubmed: 29994086
Neuro Oncol. 2012 Jul;14(7):849-58
pubmed: 22561799
Melanoma Res. 2017 Apr;27(2):145-151
pubmed: 27926588
Stat Med. 2015 Feb 20;34(4):685-703
pubmed: 25399736
Nat Med. 2018 Oct;24(10):1559-1567
pubmed: 30224757
J Dtsch Dermatol Ges. 2016 Sep;14(9):910-5
pubmed: 27607033
J Am Acad Dermatol. 2017 Feb;76(2):258-263
pubmed: 27887797
JAMA Netw Open. 2018 May;1(1):
pubmed: 30556054
BMJ. 2017 Jun 28;357:j2813
pubmed: 28659278
N Engl J Med. 2017 Nov 9;377(19):1824-1835
pubmed: 28891423
Mod Pathol. 2018 Oct;31(10):1502-1512
pubmed: 29899550
J Invest Dermatol. 2015 Apr;135(4):1190-1193
pubmed: 25330295
N Engl J Med. 2016 Nov 10;375(19):1845-1855
pubmed: 27717298
N Engl J Med. 2017 Nov 9;377(19):1813-1823
pubmed: 28891408
J Natl Cancer Inst. 2015 Nov 12;108(1):
pubmed: 26563354
Clin Epidemiol. 2016 May 26;8:109-22
pubmed: 27307765