1
|
Durgham RA, Nassar SI, Gun R, Nguyen SA, Asarkar AA, Nathan CAO. The Prognostic Value of the 31-Gene Expression Profile Test in Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:3714. [PMID: 39518150 PMCID: PMC11545106 DOI: 10.3390/cancers16213714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 10/30/2024] [Accepted: 11/01/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Cutaneous melanoma is an increasingly common and potentially lethal form of skin cancer. Current staging systems based on clinical and pathological features have limitations in accurately predicting outcomes, particularly for early-stage disease. The 31-gene expression profile (31-GEP) test has emerged as a promising tool for improving risk stratification in melanoma patients. METHODS We conducted a systematic review and meta-analysis of studies evaluating the prognostic performance of the 31-GEP test in cutaneous melanoma. A comprehensive literature search was performed in multiple databases. Studies reporting survival outcomes stratified by 31-GEP class were included. Random-effects models were used to determine survival estimates across studies. RESULTS Thirteen studies comprising 14,760 patients were included in the meta-analysis. The 31-GEP test consistently stratified patients into risk groups with significantly different outcomes. The 5-year melanoma-specific survival rates were 99.8% (95% CI: 98-100%) for Class 1A, 97.6% (95% CI: 92.4-99.3%) for Class 1B/2A, and 83.4% (95% CI: 66.5-92.7%) for Class 2B. Similar trends were observed for recurrence-free and distant metastasis-free survival. CONCLUSIONS This meta-analysis supports the prognostic utility of the 31-GEP test in cutaneous melanoma prognostication. The test consistently stratified patients into clinically meaningful risk groups across multiple survival metrics. These findings support the potential clinical utility of the 31-GEP test in enhancing current staging systems and informing personalized management strategies for melanoma patients.
Collapse
Affiliation(s)
- Ryan A. Durgham
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA; (R.A.D.); (S.I.N.); (S.A.N.)
| | - Sami I. Nassar
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA; (R.A.D.); (S.I.N.); (S.A.N.)
| | - Ramazan Gun
- Department of Otolaryngology—Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA; (R.G.); (A.A.A.)
| | - Shaun A. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA; (R.A.D.); (S.I.N.); (S.A.N.)
| | - Ameya A. Asarkar
- Department of Otolaryngology—Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA; (R.G.); (A.A.A.)
| | - Cherie-Ann O. Nathan
- Department of Otolaryngology—Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA; (R.G.); (A.A.A.)
| |
Collapse
|
2
|
Lallas K, Kyrgidis A, Chrysostomidis A, Vakirlis E, Apalla Z, Lallas A. Clinical, dermatoscopic, histological and molecular predictive factors of distant melanoma metastasis: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 202:104458. [PMID: 39074631 DOI: 10.1016/j.critrevonc.2024.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Melanoma metastasis to distant sites is associated with diminished survival rates and poor prognosis. Except of Breslow thickness and ulceration that are currently used in melanoma staging, the investigation of additional clinicopathological, dermatoscopic and molecular factors that could predict tumors with aggressive biologic behavior is of paramount importance. METHODS A literature search was conducted in PubMed, Scopus, Cochrane databases and gray literature until November 2023. Observational studies (including cohorts and case-control studies) were included and clinical and histopathological factors of primary cutaneous melanomas, along with dermatoscopic and molecular predictors of distant metastasis (DM) and distant metastasis-free survival (DMFS) were assessed. Random - effect models were preferred, the results were presented as Hazard Ratios (HRs) with 95 %Confidence Intervals (CIs) and the I2 index quantified heterogeneity. Subgroup analysis according to AJCC stage and sensitivity analysis were also conducted. RESULTS One hundred forty-three and 101 studies were included in the qualitive and quantitative synthesis, respectively. Regarding clinical factors, males, compared to females, and head and neck location, compared to trunk, demonstrated higher risk for DM [n=36, HR 1.49, 95%CI 1.36 - 1.63, I2 33% and n=21, HR 1.24, 95 %CI 1.01 - 1.52, I2 62 %]. Both factors had similar effects on DMFS. Breslow thickness and ulceration were significant predictors or DM. Additional factors that posed an increased risk for DM were nodular (n=15, HR 2.51, 95 %CI 1.83 - 3.43, I2 56 %) and lentigo maligna subtypes (n=12, HR 1.87, 95 %CI 1.27 - 2.75, I2 0 %), compared to superficial spreading subtype, lymphovascular invasion (n=9, HR 2.05, 95 %CI 1.18 - 3.58, I2 78 %), SLN positivity and BRAF+ mutational status. In contrast, regression was a negative predictor of DM (n=15, HR 0.59, 95 %CI 0.44 - 0.79, I2 68 %). Two studies focused on dermatoscopic factors and found that low pigmentation and the presence of blue-white veil might predict DM development. The results of subgroup analysis for stage I-II patients were essentially similar and sensitivity analysis did not reveal significant alterations, despite the moderate or high heterogeneity in some categories. CONCLUSIONS Clinical and histological characteristics of the tumor along with dermatoscopic features and molecular parameters hold significant prognostic information and could be incorporated into models to predict melanomas with high metastatic potential.
Collapse
Affiliation(s)
- Konstantinos Lallas
- Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece.
| | - Athanassios Kyrgidis
- Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Anestis Chrysostomidis
- Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece; First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Zoe Apalla
- Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| |
Collapse
|
3
|
Dixon AJ, Steinman HK, Nirenberg A, Zouboulis CC, Sladden M, Popescu C, Anderson S, Longo C, Thomas JM. BAUSSS biomarker improves melanoma survival risk assessment. J Eur Acad Dermatol Venereol 2024. [PMID: 39215563 DOI: 10.1111/jdv.20292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC) method of staging melanoma is dated and inaccurate. It ignores important prognostic melanoma features, especially the patient's age. BAUSSS is more accurate in determining survival risk for primary cutaneous melanoma patients who have no clinical or imaging evidence of nodal or distant metastases. BAUSSS is an algorithm incorporating analysis of Breslow thickness, Age, Ulceration, Subtype of melanoma, Sex and Site. These are the six features from the patient history along with the details from the melanoma pathology report that are most predictive of mortality outcome. OBJECTIVE To develop a single-page document that allows the clinician to determine BAUSSS biomarker-predicted prognosis in consultation with the patient. METHOD From various data sources, we developed an algorithm to predict melanoma mortality using the BAUSSS biomarker system. The single-page algorithm was made available to download at https://globalmelanoma.net/bausss-survival-chart, thus being readily available without charge to all clinicians and their patients. RESULTS BAUSSS method of determining melanoma prognosis is more accurate and less costly than the AJCC staging system. The only surgery the patient requires is wide local excision of the primary tumour. This method of ascertaining melanoma risk does not require added surgery, costs, hospitalization, tests and anaesthesia, such as would be required if sentinel lymph node biopsy was undertaken. BAUSSS can be a useful tool in determining which primary melanoma patients are at sufficiently high risk to be considered for adjuvant drug therapy. CONCLUSION We encourage clinicians to download and print in colour this single-page BAUSSS mortality prediction tool, laminate it, and use it face to face with the patient in consultations. Not only will the patient be able to recognize his/her long-term prognosis but will also be able to see how their tumour severity compares with others.
Collapse
Affiliation(s)
- Anthony J Dixon
- Australasian College of Cutaneous Oncology, Docklands, Victoria, Australia
- American Osteopathic College of Dermatology, Kirksville, Missouri, USA
| | - Howard K Steinman
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | | | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | | | - Catalin Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Stuart Anderson
- Australasian College of Cutaneous Oncology, Docklands, Victoria, Australia
- Maffra Medical Group, Maffra, Victoria, Australia
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | | |
Collapse
|
4
|
Zager JS, Hyams DM. Management of melanoma: can we use gene expression profiling to help guide treatment and surveillance? Clin Exp Metastasis 2024; 41:439-445. [PMID: 38064126 DOI: 10.1007/s10585-023-10241-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/03/2023] [Indexed: 09/05/2024]
Abstract
Although the incidence of cutaneous melanoma (CM) has been increasing annually, the mortality rate has been decreasing, likely due to better prevention, earlier detection, improved surveillance, and the development of new therapies. Current clinical management guidelines by the National Comprehensive Cancer Network (NCCN) are based on patient risk assignment using staging criteria established by the American Joint Committee on Cancer (AJCC). However, some patients with localized disease (stage I-II), generally considered to have a good prognosis, will develop metastatic disease and die, whereas some patients with later stage disease (stage III-IV) will be cured by surgery, adjuvant therapy, and/or systemic therapy. These results emphasize the importance of identifying patients whose risk may be over or underestimated with standard staging. Gene expression profile (GEP) tests are noninvasive molecular tests that assess the expression levels of a panel of validated genes, providing information about tumor prognosis, including the risk of recurrence, metastasis, and cancer-specific death. GEP tests can provide prognostic information beyond standard staging that may aid clinicians and patients in treatment and surveillance management decisions. This review describes how combining clinicopathologic staging with a robust assessment of tumor biology may provide information that will allow more refined intervention and long-term management.
Collapse
Affiliation(s)
- Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, 10920 McKinley Dr., Tampa, FL, 33612, USA.
| | - David M Hyams
- Desert Surgical Oncology, Eisenhower Medical Center, Rancho Mirage, CA, USA
| |
Collapse
|
5
|
Dixon AJ, Kyrgidis A, Steinman HK, Dixon JB, Sladden M, Garbe C, Lallas A, Zachary CB, Leiter-Stöppke U, Smith H, Nirenberg A, Zouboulis CC, Longo C, Argenziano G, Apalla Z, Popescu C, Tzellos T, Anderson S, Nanz L, Cleaver L, Thomas JM. Sentinel lymph node biopsy is unreliable in predicting melanoma mortality for both younger and older patients. J Eur Acad Dermatol Venereol 2024; 38:741-751. [PMID: 38168748 DOI: 10.1111/jdv.19772] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Melanoma disease patterns vary with patient age. AIM To evaluate sentinel lymph node biopsy (SLNB) in managing melanoma at differing patient ages. METHODS Online prediction tools were applied to compare SLNB positivity (SLNB+) and survival risk at patient ages 20-80. Tübingen melanoma data were used to determine variations in the hazard ratio of SLNB+ for mortality at different patient ages. RESULTS Regardless of tumour thickness, predicted SLNB+ rates were markedly higher than mortality rates for 20-year-old patients. For 80-year-old patients, it is the opposite. DISCUSSION If 1000 20-year-olds with a 0.4 mm thickness non-ulcerated melanoma underwent SLNB, 100 would likely be positive. If all 100 were to be offered adjuvant drug therapy (ADT), fewer than three more melanoma deaths in those 1000 patients would be avoided. In total, 97 patients would have received medication they may never have needed. If 1000 80-year-olds with a 3 mm thickness non-ulcerated melanoma underwent SLNB, only 40 would likely be positive. In total, 274 patients would be predicted to die of melanoma, 245 being SLNB negative and 29 SLNB+. ADT linked to SLNB+ could deny treatment to 89% of these high-risk patients. LIMITATIONS The authors relied on published risk data. CONCLUSION SLNB has poor specificity at predicting mortality in young melanoma patients and poor sensitivity in older patients. SLNB is not indicated in managing cutaneous melanoma for patients under 40 or over 60 years of age. Many such patients could be managed with wide local excision alone in their clinician's office-based practice. For all cutaneous melanoma patients at all ages, linking ADT to BAUSSS biomarker, (an algorithm of Breslow thickness, age, ulceration, subtype, sex and Site) rather than SLNB+ is likely more appropriate. BAUSSS provides a more accurate melanoma-specific mortality risk assessment for patients without burdening them with added surgery, hospitalization, costs or morbidity risk.
Collapse
Affiliation(s)
- Anthony J Dixon
- Australasian College of Cutaneous Oncology, Docklands, Victoria, Australia
| | | | | | - John B Dixon
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | | | - Ulrike Leiter-Stöppke
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Harvey Smith
- Oxford Dermatology, Perth, Western Australia, Australia
| | | | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Zoe Apalla
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Catalin Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Lena Nanz
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | | |
Collapse
|
6
|
Development of a nomogram for predicting 90-day mortality in patients with sepsis-associated liver injury. Sci Rep 2023; 13:3662. [PMID: 36871054 PMCID: PMC9985651 DOI: 10.1038/s41598-023-30235-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
The high mortality rate in sepsis patients is related to sepsis-associated liver injury (SALI). We sought to develop an accurate forecasting nomogram to estimate individual 90-day mortality in SALI patients. Data from 34,329 patients were extracted from the public Medical Information Mart for Intensive Care (MIMIC-IV) database. SALI was defined by total bilirubin (TBIL) > 2 mg/dL and the occurrence of an international normalized ratio (INR) > 1.5 in the presence of sepsis. Logistic regression analysis was performed to establish a prediction model called the nomogram based on the training set (n = 727), which was subsequently subjected to internal validation. Multivariate logistic regression analysis showed that SALI was an independent risk factor for mortality in patients with sepsis. The Kaplan‒Meier curves for 90-day survival were different between the SALI and non-SALI groups after propensity score matching (PSM) (log rank: P < 0.001 versus P = 0.038), regardless of PSM balance. The nomogram demonstrated better discrimination than the sequential organ failure assessment (SOFA) score, logistic organ dysfunction system (LODS) score, simplified acute physiology II (SAPS II) score, and Albumin-Bilirubin (ALBI) score in the training and validation sets, with areas under the receiver operating characteristic curve (AUROC) of 0.778 (95% CI 0.730-0.799, P < 0.001) and 0.804 (95% CI 0.713-0.820, P < 0.001), respectively. The calibration plot showed that the nomogram was sufficiently successful to predict the probability of 90-day mortality in both groups. The DCA of the nomogram demonstrated a higher net benefit regarding clinical usefulness than SOFA, LODS, SAPSII, and ALBI scores in the two groups. The nomogram performs exceptionally well in predicting the 90-day mortality rate in SALI patients, which can be used to assess the prognosis of patients with SALI and may assist in guiding clinical practice to enhance patient outcomes.
Collapse
|
7
|
Dixon AJ, Steinman HK, Kyrgidis A, Smith H, Sladden M, Zouboulis C, Argenziano G, Apalla Z, Lallas A, Longo C, Nirenberg A, Popescu C, Dixon JB, Tzellos T, Zachary C, Cleaver L, Anderson S, Zagarella S, Thomas JM. Improved methodology in determining melanoma mortality and selecting patients for immunotherapy. J Eur Acad Dermatol Venereol 2023. [PMID: 36785984 DOI: 10.1111/jdv.18951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Affiliation(s)
- A J Dixon
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - H K Steinman
- Campbell University, Buies Creek, North Carolina, USA
| | - A Kyrgidis
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Smith
- Oxford Dermatology, Perth, Western Australia, Australia
| | - M Sladden
- University of Tasmania, Launceston, Tasmania, Australia
| | - C Zouboulis
- Dessau Medical Center, Brandenburg Medical School, Dessau, Germany
| | | | - Z Apalla
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Lallas
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Longo
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Nirenberg
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - C Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - J B Dixon
- Swinburne University of Technology, Melbourne, Victoria, Australia
| | - T Tzellos
- Arctic University of Norway, Tromsø, Norway
| | - C Zachary
- University of California, Irvine, California, USA
| | - L Cleaver
- A.T. Still University, Kirksville, Missouri, USA
| | - S Anderson
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - S Zagarella
- University of Sydney, Sydney, New South Wales, Australia
| | - J M Thomas
- Formerly of Royal Marsden Hospital, London, UK
| |
Collapse
|