1
|
Varey AHR, Li I, El Sharouni MA, Simon J, Dedeilia A, Ch'ng S, Saw RPM, Spillane AJ, Shannon KF, Pennington TE, Rtshiladze M, Stretch JR, Nieweg OE, van Akkooi A, Sullivan RJ, Boland GM, Gershenwald JE, van Diest PJ, Scolyer RA, Long GV, Thompson JF, Lo SN. Predicting Recurrence-Free and Overall Survival for Patients With Stage II Melanoma: The MIA Calculator. J Clin Oncol 2024:JCO2301020. [PMID: 38315961 DOI: 10.1200/jco.23.01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/30/2023] [Accepted: 11/09/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE Improvements in recurrence-free survival (RFS) were demonstrated in two recent randomized trials for patients with sentinel node (SN)-negative stage IIB or IIC melanoma receiving adjuvant systemic therapy (pembrolizumab/nivolumab). However, adverse events also occurred. Accurate individualized prognostic estimates of RFS and overall survival (OS) would allow patients to more accurately weigh the risks and benefits of adjuvant therapy. Since the current American Joint Committee on Cancer eighth edition (AJCC-8) melanoma staging system focuses on melanoma-specific survival, we developed a multivariable risk prediction calculator that provides estimates of 5- and 10-year RFS and OS for these patients. METHODS Data were extracted from the Melanoma Institute Australia (MIA) database for patients diagnosed with stage II (clinical or pathological) melanoma (n = 3,220). Survival prediction models were developed using multivariable Cox regression analyses (MIA models) and externally validated twice using data sets from the United States and the Netherlands. Each model's performance was assessed using C-statistics and calibration plots and compared with Cox models on the basis of AJCC-8 staging (stage models). RESULTS The 5-year and 10-year RFS C-statistics were 0.70 and 0.73 (MIA-model) versus 0.61 and 0.60 (stage-model), respectively. For OS, the 5-year and 10-year C-statistics were 0.71 and 0.75 (MIA-model) compared with 0.62 and 0.61 (stage-model), respectively. The MIA models were well calibrated and externally validated. CONCLUSION The MIA models offer accurate and personalized estimates of both RFS and OS in patients with stage II melanoma even in the absence of pathological staging with SN biopsy. These models were robust on external validations and may be used in everyday practice both with (ideally) and without performing SN biopsy to identify high-risk patients for further management strategies. An online tool will be available at the MIA website (Risk Prediction Tools).
Collapse
Affiliation(s)
- Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Isabel Li
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mary-Ann El Sharouni
- Departments of Dermatology and Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Julie Simon
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, NSW, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Thomas E Pennington
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Rtshiladze
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alexander van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul J van Diest
- Departments of Dermatology and Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
2
|
Tedman AJ, Liyanage UE, Chong S, Rowe C, von Schuckmann LA, Malt M, Green AC, Smithers BM, Khosrotehrani K. Conditional survival in patients with stage IB-IIIA melanoma undergoing sentinel node biopsy in Queensland: A longitudinal study. Australas J Dermatol 2023; 64:e34-e40. [PMID: 36651479 DOI: 10.1111/ajd.13974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tumour characteristics such as thickness and ulceration, along with sentinel lymph node (SLN) status, have been essential in predicting survival in patients with locally invasive melanomas at the time of diagnosis. It is unclear if these prognostic factors are relevant 1, 2 or 5 years after diagnosis. OBJECTIVES The key aim of this project was to analyse conditional survival in a cohort of Queensland patients with stage IB to IIIA melanomas (American Joint Committee on Cancer's staging system, 8th version) and to test the relevance of clinicopathological prognostic factors for melanoma outcome after varying intervals of survival time. METHODS Patients with primary invasive cutaneous melanoma who were referred to a tertiary melanoma clinic and underwent SLN biopsy between 1994 and 2011 were ascertained. The effect of patient and tumour characteristics on melanoma survival were calculated using multivariate Cox proportional hazard models at diagnosis and at variable times after diagnosis. RESULTS The final analysis included 651 patients (average age 49 years, 55.5% male) with stage IB to IIIA melanoma. At diagnosis, and after 1 and 2 years survived, SLN positivity, thickness and ulceration were predictive of 10-year survival since diagnosis. However, once patients survived 5 years, only SLN status was predictive. Overall conditional melanoma survival improved with increasing time survived. Five years after diagnosis, 10-year conditional melanoma survival (MSS) was 91% (95% CI 86%-95%) compared with 85% (82%-88%) predicted at diagnosis. The improvement in MSS was observed mainly for Stage II melanoma patients and not for those with a positive SLN biopsy. CONCLUSIONS This study confirms the improvement of prognosis according to time survived since diagnosis suggesting that after 5 years survival the classic prognostic indicators may not have the same influence.
Collapse
Affiliation(s)
| | - Upekha E Liyanage
- Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Sharene Chong
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Casey Rowe
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Lena A von Schuckmann
- School of Public Health, The University of Queensland, Brisbane, Australia.,UQ Frazer Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Maryrose Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - B Mark Smithers
- Academy of Surgery, University of Queensland, Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| |
Collapse
|
3
|
Miller R, Walker S, Shui I, Brandtmüller A, Cadwell K, Scherrer E. Epidemiology and survival outcomes in stages II and III cutaneous melanoma: a systematic review. Melanoma Manag 2020; 7:MMT39. [PMID: 32399177 PMCID: PMC7212505 DOI: 10.2217/mmt-2019-0022] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim Management of cutaneous melanoma (CM) is continually evolving with adjuvant treatment of earlier stage disease. The aim of this review was to identify published epidemiological data for stages II-III CM. Materials & methods Systematic searches of Medline and Embase were conducted to identify literature reporting country/region-specific incidence, prevalence, survival or mortality outcomes in stage II and/or III CM. Screening was carried out by two independent reviewers. Results & conclusion Of 41 publications, 14 described incidence outcomes (incidence rates per stage were only reported for US and Swedish studies), 33 reported survival or mortality outcomes and none reported prevalence data. This review summarizes relevant data from published literature and highlights an overall paucity of epidemiological data in stages II and III CM.
Collapse
Affiliation(s)
- Rachael Miller
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Sophie Walker
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Irene Shui
- Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | | | - Kevin Cadwell
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | | |
Collapse
|
4
|
Bayci AWL, Baker DA, Somerset AE, Turkoglu O, Hothem Z, Callahan RE, Mandal R, Han B, Bjorndahl T, Wishart D, Bahado-Singh R, Graham SF, Keidan R. Metabolomic identification of diagnostic serum-based biomarkers for advanced stage melanoma. Metabolomics 2018; 14:105. [PMID: 30830422 DOI: 10.1007/s11306-018-1398-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/18/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Melanoma is a highly aggressive malignancy and is currently one of the fastest growing cancers worldwide. While early stage (I and II) disease is highly curable with excellent prognosis, mortality rates rise dramatically after distant spread. We sought to identify differences in the metabolome of melanoma patients to further elucidate the pathophysiology of melanoma and identify potential biomarkers to aid in earlier detection of recurrence. METHODS Using 1H NMR and DI-LC-MS/MS, we profiled serum samples from 26 patients with stage III (nodal metastasis) or stage IV (distant metastasis) melanoma and compared their biochemical profiles with 46 age- and gender-matched controls. RESULTS We accurately quantified 181 metabolites in serum using a combination of 1H NMR and DI-LC-MS/MS. We observed significant separation between cases and controls in the PLS-DA scores plot (permutation test p-value = 0.002). Using the concentrations of PC-aa-C40:3, DL-carnitine, octanoyl-L-carnitine, ethanol, and methylmalonyl-L-carnitine we developed a diagnostic algorithm with an AUC (95% CI) = 0.822 (0.665-0.979) with sensitivity and specificity of 100 and 56%, respectively. Furthermore, we identified arginine, proline, tryptophan, glutamine, glutamate, glutathione and ornithine metabolism to be significantly perturbed due to disease (p < 0.05). CONCLUSION Targeted metabolomic analysis demonstrated significant differences in metabolic profiles of advanced stage (III and IV) melanoma patients as compared to controls. These differences may represent a potential avenue for the development of multi-marker serum-based assays for earlier detection of recurrences, allow for newer, more effective targeted therapy when tumor burden is less, and further elucidate the pathophysiologic changes that occur in melanoma.
Collapse
Affiliation(s)
- A W L Bayci
- Department of General Surgery, Beaumont Health, Royal Oak, MI, USA
| | - D A Baker
- Department of General Surgery, Beaumont Health, Royal Oak, MI, USA.
- Department of Surgery, Beaumont Health, 3601 W. 13 Mile Rd., Royal Oak, MI, 48073, USA.
| | - A E Somerset
- Department of General Surgery, Beaumont Health, Royal Oak, MI, USA
| | - O Turkoglu
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, MI, USA
| | - Z Hothem
- Department of General Surgery, Beaumont Health, Royal Oak, MI, USA
| | - R E Callahan
- Department of General Surgery, Beaumont Health, Royal Oak, MI, USA
| | - R Mandal
- Department of Biological and Computing Sciences, University of Alberta Edmonton, Edmonton, AB, Canada
| | - B Han
- Department of Biological and Computing Sciences, University of Alberta Edmonton, Edmonton, AB, Canada
| | - T Bjorndahl
- Department of Biological and Computing Sciences, University of Alberta Edmonton, Edmonton, AB, Canada
| | - D Wishart
- Department of Biological and Computing Sciences, University of Alberta Edmonton, Edmonton, AB, Canada
| | - R Bahado-Singh
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, MI, USA
| | - S F Graham
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, MI, USA
| | - R Keidan
- Department of General Surgery, Beaumont Health, Royal Oak, MI, USA
| |
Collapse
|
5
|
Haydu LE, Scolyer RA, Lo S, Quinn MJ, Saw RPM, Shannon KF, Spillane AJ, Stretch JR, McCarthy WH, Thompson JF. Conditional Survival: An Assessment of the Prognosis of Patients at Time Points After Initial Diagnosis and Treatment of Locoregional Melanoma Metastasis. J Clin Oncol 2017; 35:1721-1729. [PMID: 28375785 DOI: 10.1200/jco.2016.71.9393] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Standard cancer staging and prognostic estimates are determined at the time of the patient's initial disease presentation. Conditional survival is an alternative, dynamic assessment from follow-up time points after the initial disease diagnosis and is based on the condition of survivorship. Estimates of conditional survival can provide critical prognostic information for patients and clinicians, guide subsequent cancer follow-up schedules, and influence decisions regarding treatments. The current study presents conditional survival estimates developed from a cohort of 4,540 patients diagnosed with stage III melanoma treated at a single institution. Methods Patients with stage III disease at first melanoma diagnosis (initial; n = 2,042), or who developed locoregional metastasis as a first recurrence some time after primary diagnosis (recurrent; n = 2,498), were assessed. Conditional melanoma-specific survival (MSS) estimates up to 5 years after diagnosis were adjusted for age, sex, and 8th edition American Joint Committee on Cancer (AJCC) stage. Results Older age at diagnosis of stage III disease conveyed a worse prognosis at each conditional survival time point. Males had significantly worse MSS outcomes for up to 2 years of conditional survival, after which males and females had similar MSS. For patients with AJCC stage IIIB and stage IIIC disease, MSS outcomes were similar to those of patients with stage IIIA disease after 3 and 5 years of survivorship, respectively. Conclusion Adjuvant systemic treatments may have the greatest benefit when administered within the first 2 years of stage III melanoma diagnosis, during which period prognosis is significantly worse for male patients of increasing age and AJCC substage. Conditional survival estimates illustrate improved survival prospects for patients with cancer returning for follow-up and may define a finite period of increased risk after diagnosis.
Collapse
Affiliation(s)
- Lauren E Haydu
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard A Scolyer
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Serigne Lo
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael J Quinn
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robyn P M Saw
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kerwin F Shannon
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew J Spillane
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jonathan R Stretch
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - William H McCarthy
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John F Thompson
- Lauren E. Haydu, Richard A. Scolyer, Serigne Lo, Robyn P.M. Saw, Kerwin F. Shannon, Andrew J. Spillane, Jonathan R. Stretch, and John F. Thompson: The University of Sydney, Sydney; Richard A. Scolyer, Robyn P.M. Saw, and John F. Thompson, Royal Prince Alfred Hospital, Camperdown; Michael J. Quinn, The University of Wollongong, Wollongong, NSW, Australia; and Lauren E. Haydu, University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
6
|
Abstract
Overall cancer incidence is decreasing, whereas melanoma cases are increasing. Conditional survival estimates offer a more accurate prognosis for patients the farther they are from time of diagnosis. The effect of age and stage on a melanoma patient's conditional survival estimate is unknown. Surveillance, Epidemiology, and End Results data were utilized to identify newly diagnosed cutaneous melanoma patients (N=95 041), from 1998 to 2005, with up to 12 years of follow-up. Estimates of disease-specific survival by stage and age were determined by Cox regression analysis and transformed to estimated conditional 5-year survival. Localized melanoma patients have an excellent 5-year survival at diagnosis and over subsequent years. For patients with localized and regional disease, an age effect is present for disease-specific mortality when comparing older patients (70-79 years) with younger patients (<30 years): hazard ratio (HR) for mortality 3.79 [95% confidence interval (CI) 3.01-4.84] and HR 2.36 (95% CI 1.93-2.91), respectively. No age effect difference is observed in disease-specific survival for advanced disease: HR 1.14 (95% CI 0.87-1.53). Over time, conditional survival estimates improve for older patients with localized and regional disease. This improvement is not seen in distant disease, neither is the age gradient. Disease-specific mortality and conditional survival for patients with localized and regional melanomas are initially impacted by older age, with effects dissipating over time. Age does not affect survival in patients with advanced disease. Understanding the conditional 5-year disease-specific survival of melanoma based on age and stage can help patients and physicians, informing decision-making about treatment and surveillance.
Collapse
|
7
|
Davis J, Patil J, Aydin N, Mishra A, Misra S. Capsular nevus versus metastatic malignant melanoma - a diagnostic dilemma. Int J Surg Case Rep 2016; 29:20-24. [PMID: 27810606 PMCID: PMC5094157 DOI: 10.1016/j.ijscr.2016.10.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A positive finding of metastatic melanoma in a sentinel lymph node is an ominous sign and a strong predictor of overall survival. In contrast, current data trends have shown that patients with benign nevus cells in the sentinel nodes do not require additional therapy since their prognosis has been shown to be similar to that of patients with negative lymph nodes. Distinguishing between benign capsular nevi and metastatic melanoma often proves to be diagnostically problematic. CASE PRESENTATION In this case report we present two cases of melanoma in which sentinel lymph node biopsies proved to be difficult in distinguishing metastatic melanocytes from capsular nevus cells. In both cases, further workup was necessary for accurate diagnoses. DISCUSSION A lack of standardized distinctions of benign nevus cell from melanoma pose a diagnostic pitfall. Assigning a diagnosis of malignant melanoma might seem like the safer approach to avoid a false negative, but the resultant treatment, including the possibility of additional surgical complications, may cause anxiety, discomfort, and financial instability for the patient. Current methods of distinguishing the two based solely on histology may be insufficient due to similar pathologic patterns. CONCLUSION To avoid misdiagnosing a patient and performing unnecessary therapy, it would be beneficial to get a second opinion by additional histopathologists at a high volume center. Additionally, immunohistochemical staining should be carefully employed due to some overlap in commonly used markers. Using tissue morphology in conjunction with immunohistochemical staining may be the best way to make the most accurate diagnosis.
Collapse
Affiliation(s)
- Justin Davis
- Texas Tech Health Sciences Center, Amarillo, TX, United States
| | | | - Nail Aydin
- Texas Tech Health Sciences Center, Amarillo, TX, United States
| | | | - Subhasis Misra
- Texas Tech Health Sciences Center, Amarillo, TX, United States.
| |
Collapse
|
8
|
Gambichler T, Scholl L, Bechara F, Stockfleth E, Stücker M. Worse outcome for patients with recurrent melanoma after negative sentinel lymph biopsy as compared to sentinel-positive patients. Eur J Surg Oncol 2016; 42:1420-6. [DOI: 10.1016/j.ejso.2016.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/09/2016] [Accepted: 03/31/2016] [Indexed: 11/30/2022] Open
|
9
|
Burke EE, Portschy PR, Tuttle TM, Kuntz KM. Completion Lymph Node Dissection or Observation for Melanoma Sentinel Lymph Node Metastases: A Decision Analysis. Ann Surg Oncol 2016; 23:2772-8. [PMID: 27194553 DOI: 10.1245/s10434-016-5273-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term, randomized trial results comparing completion lymph node dissection (CLND) with observation for patients with sentinel lymph node (SLN) metastases are not available. Our goal was to determine whether melanoma patients with SLN metastases should undergo CLND. METHODS We developed a Markov model to simulate the prognosis of hypothetical cohorts of patients with SLN metastases who underwent either immediate CLND or observation with delayed CLND if macroscopic disease developed. Model parameters were derived from published studies and included the likelihood of non-SLN metastases, risk of dying from melanoma, CLND complication rates, and health-related quality-of-life weights. Outcomes included 5-year overall survival (OS), life expectancy (LE), and quality-adjusted life expectancy (QALE). RESULTS The projected 5-year OS for 50-year-old patients with SLN metastases who underwent immediate CLND was 67.2 % compared with 63.1 % for the observation group. The LE gained by undergoing immediate CLND ranged from 2.19 years for patients aged 30 to 0.64 years for patients aged 70 years. The QALE gained by undergoing immediate CLND ranged from 1.39 quality-adjusted life years for patients aged 30 to 0.36 for patients aged 70 years. In sensitivity analysis over a clinically plausible range of values for each input parameter, immediate CLND was no longer beneficial when the rate of long-term complications increased and the quality-of-life weight for long-term complications decreased. CONCLUSIONS Immediate CLND following positive SLN biopsy was associated with OS and QALE gains compared with observation and delayed CLND for those who develop clinically apparent LN metastases.
Collapse
Affiliation(s)
- Erin E Burke
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Pamela R Portschy
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA. .,Division of Surgical Oncology, University of Minnesota, Minneapolis, MN, USA.
| | - Karen M Kuntz
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
10
|
Abstract
Although now commonplace in contemporary cancer care, the systematic approach to classification of disease-specific cancers into a formalized staging system is a relatively modern concept. Overall, the goals of cancer staging are to characterize the status of cancer at a specific moment in time, risk stratify, facilitate prognostication, and inform clinical decision making. The revisions to the American Joint Committee on Cancer (AJCC) melanoma staging system over time reflect changes in our understanding of the biology of the disease. Since the 1st edition, where tumor thickness was defined anatomically by its relationship to the reticular or papillary dermis (Clark level) as well as tumor thickness (Breslow thickness), there have been significant strides in our use of clinicopathological variables to stratify low- versus high-risk patients. Management of the regional nodal basin has also changed dramatically over time, impacted by techniques such as lymphatic mapping and sentinel lymph node biopsy (SLNB) and changes in pathological evaluation of the regional lymph nodes. Additionally, stratification of distant metastases has evolved as survival outcomes have been shown to vary based upon anatomic site of metastases and serum lactate dehydrogenase levels. The variables in use in the current (7th edition) AJCC staging system are surrogate markers of biology with validated impact of survival outcomes. Going forward, it is likely that these and additional clinicopathological factors will be integrated with molecular and other correlates of melanoma tumor biology to further refine and personalize melanoma staging.
Collapse
|
11
|
West C, Saleh D, Peach H. Combined clearance of pelvic and superficial nodes for clinical groin melanoma. J Plast Reconstr Aesthet Surg 2014; 67:1711-8. [DOI: 10.1016/j.bjps.2014.08.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/17/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
|
12
|
Khosrotehrani K, van der Ploeg APT, Siskind V, Hughes MC, Wright A, Thomas J, Barbour A, Allan C, Bayley G, Eggermont A, Verhoef C, Smithers BM, Green AC. Nomograms to predict recurrence and survival in stage IIIB and IIIC melanoma after therapeutic lymphadenectomy. Eur J Cancer 2014; 50:1301-9. [PMID: 24613127 DOI: 10.1016/j.ejca.2014.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/24/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Current staging algorithms in melanoma patients undergoing therapeutic lymph node dissection (LND) fail to accurately distinguish long-term survivors from those at risk of rapid relapse. Our goal was to establish and validate nomograms for predicting both recurrence and survival after LND. METHODS A prospective cohort of stage IIIB and IIIC melanoma patients was ascertained from a tertiary hospital in Brisbane, Australia. Failure-time multivariate analysis identified key factors that, in adjusted combinations, generated nomograms to predict 2-year recurrence and 5-year melanoma-specific survival. The predictive value of these nomograms was further validated in a patient cohort from Rotterdam, The Netherlands. RESULTS In 494 Australian patients, number of positive lymph nodes, extra-capsular extension and nodular histopathological subtype were the main independent predictors of 2-year recurrence while age, number of positive nodes and extra-capsular extension were the independent predictors of survival. Predictive value was confirmed in The Netherlands cohort of 331 patients. The nomograms were able to classify patients according to their 2-year recurrence and 5-year survival rates even within each stage III sub-class. CONCLUSIONS Models that include extra-capsular extension predict outcomes in patients with clinically involved lymph nodes. This tool may help tailor treatment and monitoring of this group of patients.
Collapse
Affiliation(s)
- Kiarash Khosrotehrani
- The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia; The University of Queensland, UQ Diamantina Institute, Translational Research Institute, Woolloongabba, QLD, Australia.
| | | | - Victor Siskind
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia
| | - Maria Celia Hughes
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia
| | - Annaliesa Wright
- The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia
| | - Janine Thomas
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Andrew Barbour
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Christopher Allan
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gerard Bayley
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Alexander Eggermont
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Institut de Cancérologie Gustave Roussy, Villejuif-Paris, France
| | | | - B Mark Smithers
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| |
Collapse
|
13
|
van der Leest RJT, van Steenbergen LN, Hollestein LM, de Vries E, Nijsten T, van Akkooi ACJ, Janssen-Heijnen MLG, Coebergh JWW. Conditional survival of malignant melanoma in The Netherlands: 1994-2008. Eur J Cancer 2014; 50:602-10. [PMID: 24262585 DOI: 10.1016/j.ejca.2013.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cutaneous malignant melanoma causes the majority of skin cancer related deaths and features increasing incidence and mortality rates in the Netherlands. Conditional survival analysis is performed on patients who survived the preceding year(s). METHODS Patients with invasive melanoma, as recorded in the population-based Netherlands Cancer Registry, were included. To assess prognosis of melanoma survivors according to gender and Breslow thickness, conditional five-year relative survival was calculated for lymph node negative melanoma patients and conditional one-year relative survival was analysed for melanoma patients with and without nodal involvement. FINDINGS Between 1994 and 2008, 40,050 patients developed a melanoma (stage I-III, of whom 6% with nodal involvement). Six to 8years after diagnosis, survival of patients with a 1-2mm (T2) thick melanoma equalised the general population. Conditional five-year relative survival for patients with >4mm thick (T4) melanomas increased from about 60% at diagnosis to 90% at 7years after diagnosis. Largest improvements were found in patients with thick melanomas and female patients with nodal involvement. INTERPRETATION The prognosis for melanoma survivors improved with each additional year of survival after diagnosis, except for patients with a ⩽1mm thick melanoma, who never had any excess mortality during follow-up. Conditional survival of melanoma was better amongst females, amongst those with lower Breslow thickness and nodal stage.
Collapse
Affiliation(s)
| | - Liza N van Steenbergen
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands
| | - Loes M Hollestein
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther de Vries
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Erasmus MC University Medical Center - Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Clinical Epidemiology, Viecuri Medical Centre, Venlo, The Netherlands
| | - Jan-Willem W Coebergh
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Scally CP, Wong SL. Intensity of follow-up after melanoma surgery. Ann Surg Oncol 2013; 21:752-7. [PMID: 24114053 DOI: 10.1245/s10434-013-3295-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Indexed: 11/18/2022]
Abstract
This contemporary review of melanoma surveillance strategies seeks to help practitioners examine and improve their surveillance protocols based on the currently available data. In general, there is no definitive benefit from increased screening or more aggressive use of interval imaging. Low-intensity surveillance strategies do not appear to adversely affect patient outcomes and should be the preferred approach compared with high-intensity strategies for most melanoma patients. All surveillance programs should emphasize education in order to maximize the effectiveness of patient-based detection of recurrent disease.
Collapse
|
15
|
Shack L, Bryant H, Lockwood G, Ellison LF. Conditional relative survival: A different perspective to measuring cancer outcomes. Cancer Epidemiol 2013; 37:446-8. [DOI: 10.1016/j.canep.2013.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/20/2013] [Accepted: 03/19/2013] [Indexed: 11/15/2022]
|
16
|
Bianchi M, Becker A, Hansen J, Trinh QD, Tian Z, Abdollah F, Briganti A, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI, Sun M. Conditional survival after nephrectomy for renal cell carcinoma (RCC): changes in future survival probability over time. BJU Int 2013; 111:E283-9. [DOI: 10.1111/bju.12115] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Jens Hansen
- Martini-Clinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg; Germany
| | | | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal; Canada
| | - Firas Abdollah
- Department of Urology; Vita-Salute San Raffaele University; Milan; Italy
| | - Alberto Briganti
- Department of Urology; Vita-Salute San Raffaele University; Milan; Italy
| | - Shahrokh F. Shariat
- Department of Urology; Weill Medical College of Cornell University; New York; NY; USA
| | - Paul Perrotte
- Department of Urology; University of Montreal Health Center; Montreal; Canada
| | - Francesco Montorsi
- Department of Urology; Vita-Salute San Raffaele University; Milan; Italy
| | | | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal; Canada
| |
Collapse
|
17
|
Gambichler T, Scholl L, Stücker M, Bechara FG, Hoffmann K, Altmeyer P, Othlinghaus N. Clinical characteristics and survival data of melanoma patients with nevus cell aggregates within sentinel lymph nodes. Am J Clin Pathol 2013; 139:566-73. [PMID: 23596107 DOI: 10.1309/ajcpg83cmavfbwlc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Histopathologic differentiation of nevus cell aggregates and metastatic melanoma in lymph nodes is challenging. Patients with melanoma who had undergone sentinel lymph node (SLN) biopsy were evaluated using univariate and multivariate analyses as well as Kaplan-Meier statistics. Of the 651 patients, 50 (7.7%) had a nodal nevus in the SLN. In the logistic regression model, primary melanoma on the lower extremities proved to be the strongest independent negative predictor of nodal nevi with an odds ratio of 0.11 (95% confidence interval, 0.034-0.36; P = .0002). Overall 5-year survival (P = .17) and 5-year disease-free survival (P = .45) of patients with nodal nevi did not significantly differ from that of patients with negative SLNs. The frequency and anatomic localization of nodal nevi observed in the present study are in line with previous studies. Our 5-year survival data clearly demonstrate that nevus cell aggregates in lymph nodes have to be considered a benign condition even though it occurs in patients with melanoma. This study provides an indirect proof of validity and accuracy of current histopathologic methods for differentiation between nodal nevi and melanoma metastasis.
Collapse
Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Lisa Scholl
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Falk G. Bechara
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Klaus Hoffmann
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Peter Altmeyer
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Nick Othlinghaus
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| |
Collapse
|
18
|
Variability in melanoma post-treatment surveillance practices by country and physician specialty: a systematic review. Melanoma Res 2013; 22:376-85. [PMID: 22914178 DOI: 10.1097/cmr.0b013e328357d796] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
There are no evidence-based guidelines for the surveillance of patients with melanoma following surgical treatment. We carried out a systematic review to identify by country and physician specialty the current stage-specific surveillance practices for patients with melanoma. Three major medical indices, MEDLINE, the Cochrane Library database, and Scopus, were reviewed to identify articles published from January 1970 to October 2011 that included detailed information about the surveillance of patients with melanoma after the initial surgical treatment. Data on surveillance intervals and recommended evaluation were extracted and categorized by country and, when reported, physician specialty. One hundred and four articles from 10 countries and four physician specialties (dermatology, surgical oncology, medical oncology, and general practice) fulfilled the inclusion criteria, including 43 providing specific patient-level data. The articles showed a wide variation with respect to the surveillance intervals and recommended evaluations. The variation was greatest for patients with stage I disease, for whom the follow-up frequency ranged from one to six visits per year during years 1 and 2 after treatment. All four physician specialties agreed that for years 1-3, the follow-up frequency should be four times per year for all patients. For years 4 and 5, surgical oncologists recommended two follow-up visits per year, whereas general practitioners, dermatologists, and medical oncologists recommended four visits per year. Recommended imaging and laboratory evaluations were most intense in the UK and most minimalist in the Netherlands. Although general practitioners did not recommend routine laboratory or imaging tests for surveillance, all other specialties utilized both in their surveillance practice. Self skin-examination was recommended for surveillance in all countries and by all practitioner specialties. There are significant intercountry and interspecialty variations in the surveillance of patients with melanoma. As the number of melanoma survivors increases, it will be critical to examine the benefits and costs of various follow-up strategies to establish consensus guidelines for melanoma post-treatment surveillance.
Collapse
|
19
|
Conditional survival and cause-specific mortality after autologous hematopoietic cell transplantation for hematological malignancies. Leukemia 2012. [PMID: 23183426 PMCID: PMC3776451 DOI: 10.1038/leu.2012.311] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The probability of survival is conventionally calculated from autologous hematopoietic cell transplantation (aHCT). Conditional survival takes into account the changing probability of survival with time survived, but is not known for aHCT populations. We determined disease-, and cause-specific conditional survival for 2388 patients treated with aHCT over a period of 20 years at a single institution. A total of 1054 deaths (44% of the cohort) were observed: 78% attributed to recurrent disease; 9% to subsequent malignancies; and 6% to cardiopulmonary disease. Estimated probability of relative survival was 62% at 5 and 50% at 10 years from aHCT. On the other hand, 5-year relative survival was 70%, 75%, 81%, and 88% after having survived 1, 2, 5, and 10 years after aHCT, respectively. The cohort was at a 13.9-fold increased risk of death compared with the general population (95%CI=13.1–14.8). The risk of death approached that of the general population for 10-year survivors (SMR=1.4, 95%CI=0.9–1.9), with the exception of female Hodgkin lymphoma patients transplanted before 1995 at age 40 years or younger (SMR=6.0, 95%CI=1.9–14.0). Among those who had survived 10 years, non-relapse-related mortality rates exceeded relapse-related mortality rates. This study provides clinically relevant survival estimates after aHCT, and helps inform interventional strategies.
Collapse
|
20
|
Egger ME, Callender GG, McMasters KM, Ross MI, Martin RCG, Edwards MJ, Urist MM, Noyes RD, Sussman JJ, Reintgen DS, Stromberg AJ, Scoggins CR. Diversity of stage III melanoma in the era of sentinel lymph node biopsy. Ann Surg Oncol 2012; 20:956-63. [PMID: 23064795 DOI: 10.1245/s10434-012-2701-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy for melanoma often detects minimal nodal tumor burden. Although all node-positive patients are considered stage III, there is controversy regarding the necessity of adjuvant therapy for all patients with tumor-positive SLN. METHODS Post hoc analysis was performed of a prospective multi-institutional study of patients with melanoma ≥ 1.0 mm Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for patients with SLN metastasis. Kaplan-Meier analysis of disease-free survival (DFS) and overall survival (OS) was performed. Univariate and multivariate Cox regression analyses were performed. Classification and regression tree (CART) analysis also was performed. RESULTS A total of 509 patients with tumor-positive SLN were evaluated. Independent risk factors for worse OS included thickness, age, gender, presence of ulceration, and tumor-positive non-SLN (nodal metastasis found on completion lymphadenectomy). As the number of tumor-positive SLN and the total number of tumor-positive nodes (SLN and non-SLN) increased, DFS and OS worsened on Kaplan-Meier analysis. On CART analysis, the 5-year OS rates ranged from 84.9% (women with thickness < 2.1 mm, age < 59 years, no ulceration, and tumor-negative non-SLN) to 14.3% (men with thickness ≥ 2.1 mm, age ≥ 59 years, ulceration present, and tumor-positive non-SLN). Six distinct subgroups were identified with 5-year OS in excess of 70%. CONCLUSIONS Stage III melanoma in the era of SLN is associated with a very wide range of prognosis. CART analysis of prognostic factors allows discrimination of low-risk subgroups for which adjuvant therapy may not be warranted.
Collapse
Affiliation(s)
- Michael E Egger
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Yu XQ, Baade PD, O'Connell DL. Conditional survival of cancer patients: an Australian perspective. BMC Cancer 2012; 12:460. [PMID: 23043308 PMCID: PMC3519618 DOI: 10.1186/1471-2407-12-460] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Estimated conditional survival for cancer patients diagnosed at different ages and disease stage provides important information for cancer patients and clinicians in planning follow-up, surveillance and ongoing management. METHODS Using population-based cancer registry data for New South Wales Australia, we estimated conditional 5-year relative survival for 11 major cancers diagnosed 1972-2006 by time since diagnosis and age and stage at diagnosis. RESULTS 193,182 cases were included, with the most common cancers being prostate (39,851), female breast (36,585) and colorectal (35,455). Five-year relative survival tended to increase with increasing years already survived and improvement was greatest for cancers with poor prognosis at diagnosis (lung or pancreas) and for those with advanced stage or older age at diagnosis. After surviving 10 years, conditional 5-year survival was over 95% for 6 localised, 6 regional, 3 distant and 3 unknown stage cancers. For the remaining patient groups, conditional 5-year survival ranged from 74% (for distant stage bladder cancer) to 94% (for 4 cancers at different stages), indicating that they continue to have excess mortality 10-15 years after diagnosis. CONCLUSION These data provide important information for cancer patients, based on age and stage at diagnosis, as they continue on their cancer journey. This information may also be used by clinicians as a tool to make more evidence-based decisions regarding follow-up, surveillance, or ongoing management according to patients' changing survival expectations over time.
Collapse
Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
| | | | | |
Collapse
|
22
|
Ascierto PA, Grimaldi AM, Curti B, Faries MB, Ferrone S, Flaherty K, Fox BA, Gajewski TF, Gershenwald JE, Gogas H, Grossmann K, Hauschild A, Hodi FS, Kefford R, Kirkwood JM, Leachmann S, Maio M, Marais R, Palmieri G, Morton DL, Ribas A, Stroncek DF, Stewart R, Wang E, Mozzillo N, Marincola FM. Future perspectives in melanoma research. Meeting report from the "Melanoma research: a bridge from Naples to the World. Napoli, December 5th-6th 2011". J Transl Med 2012; 10:83. [PMID: 22551296 PMCID: PMC3390271 DOI: 10.1186/1479-5876-10-83] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 05/02/2012] [Indexed: 02/08/2023] Open
Abstract
After more than 30 years, landmark progress has been made in the treatment of cancer, and melanoma in particular, with the success of new molecules such as ipilimumab, vemurafenib and active specific immunization. After the first congress in December 2010, the second edition of “Melanoma Research: a bridge from Naples to the World” meeting, organized by Paolo A. Ascierto (INT, Naples, Italy), Francesco M. Marincola (NIH, Bethesda, USA), and Nicola Mozzillo (INT, Naples, Italy) took place in Naples, on 5–6 December 2011. We have identified four new topics of discussion: Innovative Approaches in Prevention, Diagnosis and Surgical Treatment, New Pathways and Targets in Melanoma: An Update about Immunotherapy, and Combination Strategies. This international congress gathered more than 30 international faculty members and was focused on recent advances in melanoma molecular biology, immunology and therapy, and created an interactive atmosphere which stimulated discussion of new approaches and strategies in the field of melanoma.
Collapse
Affiliation(s)
- Paolo A Ascierto
- Department of Melanoma, Sarcoma, and Head and Neck Disease, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Leong SPL, Gershenwald JE, Soong SJ, Schadendorf D, Tarhini AA, Agarwala S, Hauschild A, Soon CWM, Daud A, Kashani-Sabet M. Cutaneous melanoma: a model to study cancer metastasis. J Surg Oncol 2011; 103:538-49. [PMID: 21480247 DOI: 10.1002/jso.21816] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nodal status in melanoma is a critically important prognostic factor for patient outcome. The survival rate drops to <10% when melanoma has spread beyond the regional lymph nodes and includes visceral involvement. In general, the process of melanoma metastasis is progressive in that dissemination of melanoma from the primary site to the regional lymph nodes occurs prior to systemic disease. The goal of this review article is to describe melanoma as a clinical model to study cancer metastasis. A future challenge is to develop a molecular taxonomy to subgroup melanoma patients at various stages of tumor progression for more accurate targeted treatment.
Collapse
Affiliation(s)
- Stanley P L Leong
- Center for Melanoma Research and Treatment and Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, California 94115, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Staging of cutaneous melanoma continues to evolve through identification and rigorous analysis of potential prognostic factors. In 1998, the American Joint Committee on Cancer (AJCC) Melanoma Staging Committee developed the AJCC melanoma staging database, an international integrated compilation of prospectively accumulated melanoma outcome data from several centers and clinical trial cooperative groups. Analysis of this database resulted in major revisions to the TNM staging system reflected in the sixth edition of the AJCC Cancer Staging Manual published in 2002. More recently, the committee's analysis of an updated melanoma staging database, including prospective data on more than 50,000 patients, led to staging revisions adopted in the seventh edition of the AJCC Cancer Staging Manual published in 2009. This article highlights these revisions, reviews relevant prognostic factors and their impact on staging, and discusses emerging tools that will likely affect future staging systems and clinical practice.
Collapse
Affiliation(s)
- Paxton V Dickson
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA
| | | |
Collapse
|
25
|
Baade PD, Youlden DR, Chambers SK. When do I know I am cured? Using conditional estimates to provide better information about cancer survival prospects. Med J Aust 2011; 194:73-7. [PMID: 21241220 DOI: 10.5694/j.1326-5377.2011.tb04171.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 10/07/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report the latest conditional survival estimates for patients with cancer in Queensland, Australia. DESIGN, SETTING AND PARTICIPANTS Descriptive study of state-wide population-based data from the Queensland Cancer Registry on patients aged 15-89 years who were diagnosed with invasive cancer between 1982 and 2007. MAIN OUTCOME MEASURE Conditional 5-year relative survival for the 13 most common types of invasive cancer, and all cancers combined. RESULTS The prognosis for patients with cancer generally improves with each additional year that they survive. A significant excess in mortality compared with the general population ceases to occur within 10 years after diagnosis for survivors of stomach, colorectal, cervical and thyroid cancer and melanoma, with these groups having a conditional 5-year relative survival of at least 95% after 10 years. For the remaining cancers we studied (pancreatic, lung, breast, prostate, kidney, and bladder cancer, non-Hodgkin lymphoma, and leukaemia), conditional 5-year relative survival estimates (at 10 years after diagnosis) ranged from 82% to 94%, suggesting that patients in these cohorts continue to have poorer survival compared with the age-matched general population. CONCLUSIONS Estimates of conditional survival have the potential to provide useful information for cancer clinicians, patients and their carers as they are confronted by personal and surveillance-related decisions. This knowledge may be effective in building realistic hope and helping people manage uncertainty about the future. We suggest that measures of conditional survival be incorporated into routine statistical reporting in Australia.
Collapse
Affiliation(s)
- Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia.
| | | | | |
Collapse
|
26
|
Wang SJ, Wissel AR, Luh JY, Fuller CD, Kalpathy-Cramer J, Thomas CR. An interactive tool for individualized estimation of conditional survival in rectal cancer. Ann Surg Oncol 2011; 18:1547-52. [PMID: 21207162 DOI: 10.1245/s10434-010-1512-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND For rectal cancer patients who have already survived a period of time after diagnosis, survival probability changes and is more accurately depicted by conditional survival. The specific aim of this study was to develop an interactive tool for individualized estimation of changing prognosis for rectal cancer patients. METHODS A multivariate Cox proportional hazards (CPH) survival model was constructed using data from rectal cancer patients diagnosed from 1994 to 2003 from the Surveillance, Epidemiology, and End Results (SEER) database. Age, race, sex, and stage were used as covariates in the survival prediction model. The primary outcome variable was overall survival conditional on having survived up to 5 years from diagnosis. RESULTS Data from 42,830 rectal cancer patients met the inclusion criteria. The multivariate CPH model showed age, race, sex, and stage as significant independent predictors of survival. The survival prediction model demonstrated good calibration and discrimination, with a bootstrap-corrected concordance index of 0.75. A web-based prediction tool was built from this regression model that can compute individualized estimates of changing prognosis over time. CONCLUSIONS An interactive prediction modeling tool can estimate prognosis for rectal cancer patients who have already survived a period of time after diagnosis and treatment. Having more accurate prognostic information can empower both patients and clinicians to be able to make more appropriate decisions regarding follow-up, surveillance testing, and future treatment.
Collapse
Affiliation(s)
- Samuel J Wang
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA.
| | | | | | | | | | | |
Collapse
|
27
|
|