Alicia Barreiro-Capurro1, Juan J Andrés-Lencina2, Sebastian Podlipnik1, Cristina Carrera3, Celia Requena4, Esperanza Manrique-Silva4, Pietro Quaglino5, Luca Tonella5, Ane Jaka6, Nina Richarz6, José L Rodríguez-Peralto2, Pablo Ortiz2, Aram Boada6, Simone Ribero5, Eduardo Nagore4, Josep Malvehy3, Susana Puig7. 1. Department of Dermatology, Hospital Clínic de Barcelona, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain. 2. Department of Dermatology, Institute I+12, Hospital 12 de Octubre, Medical School, University Complutense, CIBERONC, Madrid, Spain. 3. Department of Dermatology, Hospital Clínic de Barcelona, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain. 4. Department of Dermatology, Instituto Valenciano de Oncología, València, Spain. 5. Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy. 6. Dermatology Department, Hospital Universitari Germans Trias I Pujol, Institut D'Investigació Germans Trias I Pujol (IGTP), Universitat Autònoma de Barcelona. Badalona, Spain. 7. Department of Dermatology, Hospital Clínic de Barcelona, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain. Electronic address: susipuig@gmail.com.
Abstract
BACKGROUND: The 8th edition of the AJCC manual for melanoma includes many changes leading to major substage migrations, which could lead to important clinical reassessments. OBJECTIVES: To evaluate the differences and prognostic value of the 8th AJCC classification in comparison with the 7th edition. METHODS: Clinical and histopathological data were retrieved from five melanoma referral centers including 7815 melanoma patients diagnosed between January 1998 and December 2018. All patients were reclassified and compared using the 7th and 8th classifications of the AJCC. Sankey plots were used to evaluate the migration of patients between the different versions. The primary outcome was overall survival (OS), and curves based on the Kaplan-Meier method were used to investigate survival differences between the 7th and 8th editions. RESULTS: The number of patients classified as stages IB, IIIA, and IIIB decreased while the patients classified as stages IA and IIIC increased notably. Migration analysis showed that many patients in group I were understaged whereas a significant percentage of patients in group III were upstaged. Indirect OS analysis showed a loss in the linearity in the AJCC 8th edition and the groups tended to overlap. Direct OS analysis between groups and versions of the AJCC showed a better prognosis within the new stage III patients, with no effect on those in stages I and II. CONCLUSION: The 8th AJCC edition represents an important change in the classification of patients. We observe that the main migratory changes occur in stage I and III, that severity linearity is lost and groups overlap, and that a more advanced stage does not mean a worse prognosis.
BACKGROUND: The 8th edition of the AJCC manual for melanoma includes many changes leading to major substage migrations, which could lead to important clinical reassessments. OBJECTIVES: To evaluate the differences and prognostic value of the 8th AJCC classification in comparison with the 7th edition. METHODS: Clinical and histopathological data were retrieved from five melanoma referral centers including 7815 melanomapatients diagnosed between January 1998 and December 2018. All patients were reclassified and compared using the 7th and 8th classifications of the AJCC. Sankey plots were used to evaluate the migration of patients between the different versions. The primary outcome was overall survival (OS), and curves based on the Kaplan-Meier method were used to investigate survival differences between the 7th and 8th editions. RESULTS: The number of patients classified as stages IB, IIIA, and IIIB decreased while the patients classified as stages IA and IIIC increased notably. Migration analysis showed that many patients in group I were understaged whereas a significant percentage of patients in group III were upstaged. Indirect OS analysis showed a loss in the linearity in the AJCC 8th edition and the groups tended to overlap. Direct OS analysis between groups and versions of the AJCC showed a better prognosis within the new stage III patients, with no effect on those in stages I and II. CONCLUSION: The 8th AJCC edition represents an important change in the classification of patients. We observe that the main migratory changes occur in stage I and III, that severity linearity is lost and groups overlap, and that a more advanced stage does not mean a worse prognosis.