Hot Off the Press (sort of)! New AJCC Staging guidelines.

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TexMelanomex
11/23/2017 6:05pm
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Replies: 3

Hey warriors, someone may have already posted this or a link to it but I didn't see it so if I'm being redundant just skip.

Melanoma Staging: Evidence-Based Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual. Gershenwald, Scoyler, Hess, Sondak, Long, Ross, Lazar, Faries, Kirkwood, McArthur, Haydu, Eggermont, Flaherty, Balch, and Thompson. NOV/DEC 2017, CA: A Cancer Journal for Clnicians. 

(I included the full citation in case any of you have docs that authored). We will need Bubbles or someone smarter than I am to decipher some of this but here are the main points.

This will likely be of most use when reading path reports or notes. I suppose there might also be some treatment implications to follow. Although the Eighth addition was published in OCT 2016, it will not be formally adopted in the US until 1 JAN 2018.

Based on 46,000 melanoma patients, from 10 centers worldwide, with stages I-III melanoma, since 1998, the following changes have been established.

1) Tumor thickness measurements to be recorded to the nearest 0.1mm not 0.01mm

2) Definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <.08 mm with ulceration) with mitotic rate no longer being a T category criterion.

3) Pathological (but not clinical) stage IA is revised to includeT1b NO MO (formerly pathological stage IB).

4) The N category descriptors "microscopic" and "macroscopic" for regional node metastasis are redifined as "clinically occult" and "clinically apparent".

5) Prognostic stage III groupings are based on N category and T category criteria (i.e., primary tumor thickness and ulceration) are increased from 3 to 4 groupings (stages IIIA-IIID).

6) Definitions of N subcategories are revised, with or without the presence of microsatellites, satellites, or in-transit metastases, now categorized as N1c, N2c, or N3c based on the number of tumor involved regional lymph nodes, if any.

7) Descriptors are added to each M1 subcategories for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c.

8) A new M1d designation is added for central nervous system mestastasis.

Tex

So does this mean mitosis is not a high risk factor anymore?  *confused*

Strength and Courage,

Susan

I'll give you my two cents worth and quote the article directly. What I took away from the article was that there was no statistical difference in hazard ratio among people who had 1 or more mitosis per mm(squared) than among people who had less than 1 per mm(squared). 

They state:

"Mitotic rate of >1 mitosis per mm(squared) had a hazard ratio (HR) of  0.85 versus a mitotic rate of <1 mitosis per mm(squared) p=.57. On the basis of these analyses of patients with T1 melanomas, tumor thickness (when dichotomized as <.08mm and 0.8-1.0mm) and ulceration were stronger predictors of MSS than mitotic rate".

I believe in looking at Hazard Ratios a ratio of 1 is the cutoff and if the number is significantly greater than 1 then they can clearly say that survival was better in one group. In the study, they also state that "melanoma with ulceration had an HR of 2.6 versus non-ulcerated melanoma" They also found that among 7568 patients with a T1N0 melanoma, tumor thickness >.08mm had an HR of 1.7 versus tumor thickness of < .08mm. 

All of this is statistical and statistically I'm in the "bad" group with the ulceration and thickness and only because of the change in staging guidelines I am now, or soon will be, out of the mitotic rate "bad" group...but I'm still here almost a year after initial diagnosis :-) But I suppose all of the early staging info goes out the window once hit stage IV.

This is what I meant when I said we'd probably need someone with a lot more Melanoma knowledge than I have...it's been over 12 years since I've had a statistics class. Hope that helped rather than clouded the picture!

Tex

One more quick note, the authors do mention that mitotic rate is important prognostically and will still be assessed although it will not be used for staging in the eighth edition.

Tex