Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 1;22(1):720.
doi: 10.1186/s12885-022-09781-0.

A population-based validation study of the 8th edition UICC/AJCC TNM staging system for cutaneous melanoma

Matthew C Hynes  1   2 , Paul Nguyen  3 , Patti A Groome  4 , Yuka Asai  1   5 , Meaghan E Mavor  4 , Tara D Baetz  1   6 , Timothy P Hanna  7   8   9   10
Affiliations

A population-based validation study of the 8th edition UICC/AJCC TNM staging system for cutaneous melanoma

Matthew C Hynes et al. BMC Cancer. .

Abstract

Background: The 8th edition UICC/AJCC TNM8 (Tumour, Nodes, Metastasis) melanoma staging system introduced several modifications from the 7th edition (TNM7), resulting in changes in survival and subgroup composition. We set out to address the limited validation of TNM8 (stages I-IV) in large population-based datasets.

Methods: This retrospective cohort-study included 6,414 patients from the population-based Ontario Cancer Registry diagnosed with cutaneous melanoma between January 1, 2007 and December 31, 2012. Kaplan-Meier curves estimated the melanoma-specific survival (MSS) and overall survival (OS). Cox proportional hazard models were used to estimate adjusted hazard ratios for MSS and OS across stage groups. The Schemper-Henderson measure was used to assess the variance explained in the Cox regression.

Results: In our sample, 21.3% of patients were reclassified with TNM8 from TNM7; reclassifications in stage II were uncommon, and 44.1% of patients in stage III were reclassified to a higher subgroup. Minimal changes in MSS curves were observed between editions, but the stage IIB curve decreased and the stage IIIC curve increased. For TNM8, Stage I (n = 4,556), II (n = 1,206), III (n = 598), and IV (n = 54) had an estimated 5-year MSS of 98.4%, 82.5%, 66.4%, and 14.4%, respectively. Within stage III, IIIA 5-year MSS was 91.7% while stage IIID was 23.5%. HRs indicated that TNM8 more evenly separates subgroups once adjusted for patient- and disease-characteristics. The variance in MSS explained by TNM7 and TNM8 is 18.9% and 19.7%, respectively.

Conclusion: TNM8 performed well in our sample, with more even separation of stage subgroups and a modest improvement in predictive ability compared to TNM7.

Keywords: Cohort studies; Melanoma; Neoplasm staging; Ontario; Prognosis; Skin neoplasms; Survival analysis.

PubMed Disclaimer

Conflict of interest statement

TDB reports unrelated advisory board/honorarium for Astra Zeneca, Abbvie, Gilead, Roche, Novartis, Merck, and Bristol Myers Squibb. YA reports unrelated research grants from the Canadian Dermatology Foundation, Sanofi, Pfizer, Leo Pharma, and Novartis and honoraria from the Canadian Society for Allergy and Immunology, Medexus, Janssen, Eli Lilly, Pfizer, UCB, L’Oreal, Aralez, Bausch and Novartis. The remaining authors have no declarations of competing interest.

Figures

Fig. 1
Fig. 1
Identification of invasive cutaneous melanoma patients and their pathology records in Ontario from January 1, 2007 to December 31, 2012
Fig. 2
Fig. 2
Melanoma-specific survival (MSS) for the TNM (A) 7th edition and (B) 8th edition
See this image and copyright information in PMC

References

    1. Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics 2019. Toronto: Canadian Cancer Society; 2019. (cancer.ca/Canadian-Cancer-Statistics-2019-EN (accessed 7 June 2021)).
    1. Erdmann F, Lortet-Tieulent J, Schüz J, Zeeb H, Greinert R, Breitbart EW, Bray F. International trends in the incidence of malignant melanoma 1953–2008—are recent generations at higher or lower risk? Int J Cancer. 2013;132:385–400. doi: 10.1002/ijc.27616. - DOI - PubMed
    1. Langley A, Levesque L, Baetz T, Asai Y. Brief Report: Increase in Melanoma Incidence in Ontario. J Cutan Med Surg. 2018;22:476–478. doi: 10.1177/1203475418773360. - DOI - PubMed
    1. Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, Lazar AJ, Faries MB, Kirkwood JM, McArthur GA, Haydu LE, Eggermont AMM, et al. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual: Melanoma Staging: AJCC 8th Edition. CA Cancer J Clin. 2017;67:472–92. doi: 10.3322/caac.21409. - DOI - PMC - PubMed
    1. Brierley JD. TNM classification of malignant tumours. 8. Chichester: Wiley Blackwell; 2017.