Prediction of survival in patients with thin melanoma

Results from a multi-institution study

Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Giovanni Pellacani, Sara Bassoli, Caterina Longo, Pietro Quaglino, Nicola Pimpinelli, Lorenzo Borgognoni, Daniele Bergamaschi & 3 others Catherine Harwood, Odysseas Zoras, Mario Santinami

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Purpose: Cutaneous melanoma incidence is increasing. Most new cases are thin (≤ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. Patients and Methods: Data from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. Results: Median follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3% (95% CI, 83.4% to 87.2%). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, presence of LVI, and regression ≥ 50%. Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, and LVI (all P = .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). Conclusion: Our findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.

Original languageEnglish
Pages (from-to)2479-2485
Number of pages7
JournalJournal of Clinical Oncology
Volume32
Issue number23
DOIs
Publication statusPublished - Aug 10 2014

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Melanoma
Nomograms
Survival
Recurrence
Incidence
Clinical Trials
Databases
Neoplasm Metastasis
Skin

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Prediction of survival in patients with thin melanoma : Results from a multi-institution study. / Maurichi, Andrea; Miceli, Rosalba; Camerini, Tiziana; Mariani, Luigi; Patuzzo, Roberto; Ruggeri, Roberta; Gallino, Gianfranco; Tolomio, Elena; Tragni, Gabrina; Valeri, Barbara; Anichini, Andrea; Mortarini, Roberta; Moglia, Daniele; Pellacani, Giovanni; Bassoli, Sara; Longo, Caterina; Quaglino, Pietro; Pimpinelli, Nicola; Borgognoni, Lorenzo; Bergamaschi, Daniele; Harwood, Catherine; Zoras, Odysseas; Santinami, Mario.

In: Journal of Clinical Oncology, Vol. 32, No. 23, 10.08.2014, p. 2479-2485.

Research output: Contribution to journalArticle

Maurichi, A, Miceli, R, Camerini, T, Mariani, L, Patuzzo, R, Ruggeri, R, Gallino, G, Tolomio, E, Tragni, G, Valeri, B, Anichini, A, Mortarini, R, Moglia, D, Pellacani, G, Bassoli, S, Longo, C, Quaglino, P, Pimpinelli, N, Borgognoni, L, Bergamaschi, D, Harwood, C, Zoras, O & Santinami, M 2014, 'Prediction of survival in patients with thin melanoma: Results from a multi-institution study', Journal of Clinical Oncology, vol. 32, no. 23, pp. 2479-2485. https://doi.org/10.1200/JCO.2013.54.2340
Maurichi, Andrea ; Miceli, Rosalba ; Camerini, Tiziana ; Mariani, Luigi ; Patuzzo, Roberto ; Ruggeri, Roberta ; Gallino, Gianfranco ; Tolomio, Elena ; Tragni, Gabrina ; Valeri, Barbara ; Anichini, Andrea ; Mortarini, Roberta ; Moglia, Daniele ; Pellacani, Giovanni ; Bassoli, Sara ; Longo, Caterina ; Quaglino, Pietro ; Pimpinelli, Nicola ; Borgognoni, Lorenzo ; Bergamaschi, Daniele ; Harwood, Catherine ; Zoras, Odysseas ; Santinami, Mario. / Prediction of survival in patients with thin melanoma : Results from a multi-institution study. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 23. pp. 2479-2485.
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abstract = "Purpose: Cutaneous melanoma incidence is increasing. Most new cases are thin (≤ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. Patients and Methods: Data from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. Results: Median follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3{\%} (95{\%} CI, 83.4{\%} to 87.2{\%}). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, presence of LVI, and regression ≥ 50{\%}. Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, and LVI (all P = .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). Conclusion: Our findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.",
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T1 - Prediction of survival in patients with thin melanoma

T2 - Results from a multi-institution study

AU - Maurichi, Andrea

AU - Miceli, Rosalba

AU - Camerini, Tiziana

AU - Mariani, Luigi

AU - Patuzzo, Roberto

AU - Ruggeri, Roberta

AU - Gallino, Gianfranco

AU - Tolomio, Elena

AU - Tragni, Gabrina

AU - Valeri, Barbara

AU - Anichini, Andrea

AU - Mortarini, Roberta

AU - Moglia, Daniele

AU - Pellacani, Giovanni

AU - Bassoli, Sara

AU - Longo, Caterina

AU - Quaglino, Pietro

AU - Pimpinelli, Nicola

AU - Borgognoni, Lorenzo

AU - Bergamaschi, Daniele

AU - Harwood, Catherine

AU - Zoras, Odysseas

AU - Santinami, Mario

PY - 2014/8/10

Y1 - 2014/8/10

N2 - Purpose: Cutaneous melanoma incidence is increasing. Most new cases are thin (≤ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. Patients and Methods: Data from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. Results: Median follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3% (95% CI, 83.4% to 87.2%). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, presence of LVI, and regression ≥ 50%. Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, and LVI (all P = .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). Conclusion: Our findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.

AB - Purpose: Cutaneous melanoma incidence is increasing. Most new cases are thin (≤ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. Patients and Methods: Data from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. Results: Median follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3% (95% CI, 83.4% to 87.2%). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, presence of LVI, and regression ≥ 50%. Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, and LVI (all P = .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). Conclusion: Our findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.

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