In Search of a More Accurate Nodal Staging System for Melanoma: Should We Sacrifice Simplicity?
Menée à partir de données portant sur 105 785 patients atteints d'un mélanome cutané et ayant bénéficié d'une résection et d'une évaluation ganglionnaire entre 2004 et 2015 puis validée à partir de données portant sur 85 499 patients supplémentaires, cette étude évalue la performance d'un système de stadification ganglionnaire, basé sur le nombre de ganglions atteints, les métastases détectées cliniquement et les métastases en transit, pour prédire la survie des patients
In this issue of JAMA Surgery, Nguyen et al assert that the current nodal staging system set forth by the American Joint Committee on Cancer, 8th edition (AJCC-8), insufficiently stratifies the outcomes of patients with melanoma. The authors have attempted to design a new model of nodal staging to address the shortcomings of the current AJCC-8 system. With their robust statistical model and large sample size, they propose a new classification system for nodal and in-transit disease that aligns more linearly with survival. Because the management of melanoma has evolved in the past decade with new systemic therapies and the Multicenter Selective Lymphadenectomy Trial II (MSLT-II) and German Dermatologic Cooperative Oncology-Selective Lymphadenectomy Trial (DeCOG), it is appropriate to reconsider traditional staging assessments. Evaluating critiques of the AJCC-8 system must consider the methodology of the AJCC analysis and any proposed alternative staging systems.
JAMA Surgery , éditorial, 2020