To revise the staging system for cutaneous melanoma under the auspices of the American Joint Committee on Cancer (AJCC).
The prognostic factors analysis described in the companion publication (this ...issue), as well as evidence from the published literature, was used to assemble the tumor-node-metastasis criteria and stage grouping for the melanoma staging system.
Major changes include (1) melanoma thickness and ulceration but not level of invasion to be used in the T category (except for T1 melanomas); (2) the number of metastatic lymph nodes rather than their gross dimensions and the delineation of clinically occult (ie, microscopic) versus clinically apparent (ie, macroscopic) nodal metastases to be used in the N category; (3) the site of distant metastases and the presence of elevated serum lactic dehydrogenase to be used in the M category; (4) an upstaging of all patients with stage I, II, and III disease when a primary melanoma is ulcerated; (5) a merging of satellite metastases around a primary melanoma and in-transit metastases into a single staging entity that is grouped into stage III disease; and (6) a new convention for defining clinical and pathologic staging so as to take into account the staging information gained from intraoperative lymphatic mapping and sentinel node biopsy.
This revision will become official with publication of the sixth edition of the AJCC Cancer Staging Manual in the year 2002.
A completely revised staging system for cutaneous melanoma was implemented in 2003. The changes were validated with a prognostic factors analysis involving 17,600 melanoma patients from prospective ...databases. This major collaborative study of predicting melanoma outcome was conducted specifically for this project, and the results were used to finalize the criteria for this evidence-based staging system. In fact, this was the largest prognostic factors analysis of prospectively followed melanoma patients ever conducted. Important results that shaped the staging criteria involved both the tumor-node-metastasis (TNM) criteria and stage grouping for all four stages of melanoma. Major changes in the staging include: (1) melanoma thickness and ulceration are the dominant predictors of survival in patients with localized melanoma (Stages I and II); deeper level of invasion (ie, IV and V) was independently associated with reduced survival only in patients with thin or T1 melanomas. (2) The number of metastatic lymph nodes and the tumor burden were the most dominant predictors of survival in patients with Stage III melanoma; patients with metastatic nodes detected by palpation had a shorter survival compared with patients whose nodal metastases were first detected by sentinel node excision of clinically occult or "microscopic" metastases. (3) The site of distant metastases (nonvisceral versus lung versus all other visceral metastatic sites) and the presence of elevated serum lactate dehydrogenase (LDH) were the dominant predictors of outcome in patients with Stage IV or distant metastases. (4) An upstaging was implemented for all patients with Stage I, II, and III disease when a primary melanoma is ulcerated by histopathological criteria. (5) Satellite metastases around a primary melanoma and in-transit metastases were merged into a single staging entity that is grouped into Stage III disease. (6) A new convention was implemented for defining clinical and pathological staging so as to take into account the new staging information gained from lymphatic mapping and sentinel node biopsy.
The American Joint Committee on Cancer Melanoma Staging Committee proposes major changes to the TNM classification and the stage grouping for cutaneous melanoma. Analyses of prognostic factors by ...major cooperative groups and cancer centers worldwide contributed data and clinical experience to the simplified and evidence‐based recommendations.
.
Total cross sections, angular distributions, and invariant-mass distributions have been measured for the photoproduction of
pairs off free protons and off nucleons bound in the deuteron. The ...experiments were performed at the MAMI accelerator facility in Mainz using the Glasgow photon tagging spectrometer and the Crystal Ball/TAPS detector. The accelerator delivered electron beams of 1508 and 1557MeV, which produced bremsstrahlung in thin radiator foils. The tagged photon beam covered energies up to 1400MeV. The data from the free proton target are in good agreement with previous measurements and were only used to test the analysis procedures. The results for differential cross sections (angular distributions and invariant-mass distributions) for free and quasi-free protons are almost identical in shape, but differ in absolute magnitude up to 15%. Thus, moderate final-state interaction effects are present. The data for quasi-free neutrons are similar to the proton data in the second resonance region (final-state invariant masses up to
MeV), where both reactions are dominated by the
decay. At higher energies, angular and invariant-mass distributions are different. A simple analysis of the shapes of the invariant-mass distributions in the third resonance region is consistent with strong contributions of an
decay for the proton, while the reaction is dominated by a sequential decay via a
intermediate state for the neutron. The data are compared to predictions from the Two-Pion-MAID model and the Bonn-Gatchina coupled-channel analysis.
Quasi-free photoproduction of πη-pairs has been investigated from threshold up to incident photon energies of 1.4 GeV, respectively up to photon-nucleon invariant masses up to 1.9 GeV. Total cross ...sections, angular distributions, invariant-mass distributions of the πη and meson-nucleon pairs, and beam helicity asymmetries have been measured for the reactions γp → pπ0η, γn → nπ0η, γp → nπ+η, and γn → pπ–η from nucleons bound inside the deuteron. For the γp initial-state data for free protons have also been analyzed. Finally, the total cross sections for quasi-free production of π0η pairs from nucleons bound in 3He nuclei have been investigated in view of final state interaction (FSI) effects. The experiments were performed at the tagged photon beam facility of the Mainz MAMI accelerator using an almost 4π covering electromagnetic calorimeter composed of the Crystal Ball and TAPS detectors. The shapes of all differential cross section data and the asymmetries are very similar for protons and neutrons and agree with the conjecture that the reactions are dominated by the sequential Δ *3/2– → ηΔ(1232) → πηN decay chain, mainly with Δ(1700)3/2– and Δ(1940)3/2–. The ratios of the magnitude of the total cross sections also agree with this assumption. Furthermore, the absolute magnitudes of the cross sections are reduced by FSI effects with respect to free proton data.
.
Quasi-free photoproduction of
-pairs has been investigated from threshold up to incident photon energies of 1.4 GeV, respectively up to photon-nucleon invariant masses up to 1.9 GeV. Total cross ...sections, angular distributions, invariant-mass distributions of the
and meson-nucleon pairs, and beam-helicity asymmetries have been measured for the reactions
,
,
, and
from nucleons bound inside the deuteron. For the
initial-state data for free protons have also been analyzed. Finally, the total cross sections for quasi-free production of
pairs from nucleons bound in
3
He nuclei have been investigated in view of final state interaction (FSI) effects. The experiments were performed at the tagged photon beam facility of the Mainz MAMI accelerator using an almost 4
covering electromagnetic calorimeter composed of the Crystal Ball and TAPS detectors. The shapes of all differential cross section data and the asymmetries are very similar for protons and neutrons and agree with the conjecture that the reactions are dominated by the sequential
decay chain, mainly with
and
. The ratios of the magnitude of the total cross sections also agree with this assumption. However, the absolute magnitudes of the cross sections are reduced by FSI effects with respect to free proton data.
Results are presented for the first measurement of the double-polarization helicity asymmetry E for the η photoproduction reaction γ p → η p. Data were obtained using the FROzen Spin Target (FROST) ...with the CLAS spectrometer in Hall B at Jefferson Lab, covering a range of center-of-mass energy W from threshold to 2.15 GeV and a large range in center-of-mass polar angle. As an initial application of these data, the results have been incorporated into the J\"ulich model to examine the case for the existence of a narrow Ν* resonance between 1.66 and 1.70 GeV. The addition of these data to the world database results in marked changes in the predictions for the E observable using that model. As a result, further comparison with several theoretical approaches indicates these data will significantly enhance our understanding of nucleon resonances.
PDF
