Critical appraisal:Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al 2009 2

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Critical Appraisal

Article being appraised

Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009 Dec 20;27(36):6199-206 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19917835.


Applicable clinical question

Key Facts

Study Design

case series

Study aims:

To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database.

Number of Patients:

38,918

Multivariate analysis of 30,946 patients with stages I,II and III melanoma, and 7,972 patients with stage IV melanoma.
Reported outcome(s):

Survival rate (up to 20 years).

Results of outcome(s):

Stages I/II: Five-year and 10-year survival rates based on TNM classification range from 97% and 93% for patients with T1aN0M0 melanomas, and 53% to 39% for patients with T4bN0M0 melanomas (P<0.0001). Ten year survival ranged from 93% for stage IA to 39% for stage IIC melanoma (P<0.0001).

Stage III: Five-year survival rates based on TNM classification ranged from 70% to 39% for patients with T1-4N1aM0 and T1-4N3M0 melanomas respectively (P<0.0001). Five-year survival within substages were 78%, 59% and 40% for patients with stage IIIA, IIIB, and IIIC melanoma, respectively.

Stage IV: One-year survival rates were 62% for M1a, 53% for M1b, and 33% for M1c melanomas (P<0.0001). For patients with normal LDH levels at the time of staging, 1- and 2-year survival rates were 65% and 40% respectively, compared with 32% and 18% for patients with elevated LDH levels (P<.0001).

Comments on results:

Survival times were calculated from the initial melanoma diagnosis (or first distant metastasis for the Stage IV analysis) and considered censored for patients who were alive at last follow-up or who died without evidence of melanoma.

Sites of metastases and elevated serum levels of LDH are used to delineate the M1 stages into three M categories for patients with distant metastases. Serum LDH should be measured at the time of stage IV disease is documented, and if the LDH level is elevated those patients are assigned to M1c regardless of the site of their distant metastases.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias
Moderate risk of bias Comments: Please replace this text and include any additional comments in regards to your risk of bias rating

Risk of bias assessment: case series

Subject selection:
Representative of eligible patients (e.g. population-based cancer registry)
Were the outcome measures blind to pre/post-intervention?
No, but objective measures used
Follow-up complete and all patients included in the analysis?
Yes (follow-up >95%)
Result of appraisal

Jutta's tick icon.png Included




Completed by

Tamsin Parrish


Jutta's tick icon.png This appraisal has been completed.


Article
Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009 Dec 20;27(36):6199-206 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19917835.
Assigned to
User:Tamsin.parrish
Topic area
Guidelines:Melanoma
Clinical question
Form
Form:Critical appraisal


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