Table_1_Assessment of the Novel, Practical, and Prognosis-Relevant TNM Staging System for Stage I-III Cutaneous Melanoma.docx

BackgroundThe clinical TNM staging system does not differ between the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging manual. A more practical TNM staging system for patients with stage I-III cutaneous melanoma are needed.
MethodsData were accessed from the Surveillance, Epidemiology, and End Results (SEER) open database. We divided the patients into 32 groups based on the T and N categories. The Kaplan-Meier survival curves and treatment guidelines were used to proposed a new TNM staging system. Cox proportional hazards model and 1000-person-years were used to verify accuracy.
ResultsThis retrospective study included 68 861 patients from 2010 to 2015. The new proposed staging system was as follows: stage IA, T1aN0M0; stage IB, T1b/T2aN0M0; stage IIA, T3-4aN0M0 and T2bN0M0; stage IIB, T1-4aN1-2M0 and T3-4bN0M0; and stage III, T1-4aN3M0 and T1-4bN1-3M0. Hazard ratios for the new stages IB, IIA, IIB, and III, with stage IA as reference, were 4.311 (95% confidence interval [CI]: 3.217-5.778), 8.993 (95% CI: 6.637-12.186), 13.179 (95% CI: 9.435-18.407), and 20.693 (95% CI: 13.655-31.356), respectively (all p-values < 0.001). Cancer-specific mortality rates per 1000-person-years were 0.812 (95% CI: 0.674-0.978), 6.612 (95% CI: 5.936-7.364), 22.228 (95% CI: 20.128-24.547), 50.863 (95% CI: 47.472-54.496) and 120.318 (95% CI: 112.596-128.570) for stages IA, IB, IIA, IIB and III, respectively.
ConclusionWe developed a more practical and prognosis-relevant staging system than that of the 8th edition AJCC manual for patients with stage I-III cutaneous melanoma. Treatments using this new model would improve the quality of life and survival rates of patients with melanoma.

【研究背景】美国癌症联合委员会（American Joint Committee on Cancer, AJCC）分期手册第7版与第8版中的临床TNM分期系统并无差异。针对I~III期皮肤黑色素瘤患者，目前亟需更具实用性的TNM分期系统。
【研究方法】本研究从监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）开放数据库中获取数据。研究人员根据T、N分期将患者划分为32个亚组。结合卡普兰-迈耶（Kaplan-Meier）生存曲线与临床治疗指南，我们提出了全新的TNM分期系统。采用Cox比例风险模型（Cox proportional hazards model）与千人年指标验证该分期系统的准确性。
【研究结果】本项回顾性研究纳入了2010年至2015年的68861例患者。本次提出的全新分期系统如下：IA期：T1aN0M0；IB期：T1b/T2aN0M0；IIA期：T3~4aN0M0及T2bN0M0；IIB期：T1~4aN1~2M0及T3~4bN0M0；III期：T1~4aN3M0及T1~4bN1~3M0。以IA期为参照，IB、IIA、IIB及III期的风险比分别为4.311（95%置信区间[CI]：3.217~5.778）、8.993（95%CI：6.637~12.186）、13.179（95%CI：9.435~18.407）及20.693（95%CI：13.655~31.356）（所有P值均<0.001）。IA、IB、IIA、IIB及III期的千人年肿瘤特异性死亡率分别为0.812（95%CI：0.674~0.978）、6.612（95%CI：5.936~7.364）、22.228（95%CI：20.128~24.547）、50.863（95%CI：47.472~54.496）及120.318（95%CI：112.596~128.570）。
【研究结论】针对I~III期皮肤黑色素瘤患者，本研究构建了相较于美国癌症联合委员会第8版分期手册更具实用性且与预后密切相关的TNM分期系统。采用该全新分期模型指导临床治疗，可改善黑色素瘤患者的生存质量与生存率。