TY - JOUR
T1 - Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma
T2 - Comparison of nodal micrometastases versus macrometastases
AU - Balch, Charles M.
AU - Gershenwald, Jeffrey E.
AU - Soong, Seng Jaw
AU - Thompson, John F.
AU - Ding, Shouluan
AU - Byrd, David R.
AU - Cascinelli, Natale
AU - Cochran, Alistair J.
AU - Coit, Daniel G.
AU - Eggermont, Alexander M.
AU - Johnson, Timothy
AU - Kirkwood, John M.
AU - Leong, Stanley P.
AU - McMasters, Kelly M.
AU - Mihm, Martin C.
AU - Morton, Donald L.
AU - Ross, Merrick I.
AU - Sondak, Vernon K.
PY - 2010/5/10
Y1 - 2010/5/10
N2 - Purpose: To determine the survival rates and independent predictors of survival using a contemporary international cohort of patients with stage III melanoma. Patients and Methods: Complete clinicopathologic and follow-up data were available for 2,313 patients with stage III disease in an updated and expanded American Joint Committee on Cancer (AJCC) melanoma staging database. Kaplan-Meier and Cox multivariate survival analyses were performed. Results: Among all 2,313 patients with stage III disease, 81% had micrometastases, and 19% had clinically detectable macrometastases. The 5-year overall survival was 63%; it was 67% for patients with nodal micrometastases, and it was 43% for those with nodal macrometastases (P < .001). Tremendous heterogeneity in survival was observed, particularly in the microscopically detected nodal metastasis subset (from 23% to 87% for 5-year survival). Multivariate analysis demonstrated that in patients with nodal micrometastases, number of tumor-containing lymph nodes, primary tumor thickness, patient age, ulceration, and anatomic site of the primary independently predicted survival (all P < .01). When added to the model, primary tumor mitotic rate was the second-most powerful predictor of survival after the number of tumor-containing nodes. In contrast, for patients with nodal macrometastases, the number of tumor-containing nodes, primary ulceration, and patient age independently predicted survival (P < .01). Conclusion: In this multi-institutional analysis, we demonstrated remarkable heterogeneity of prognosis among patients with stage III melanoma, especially among those with nodal micrometastases. These results should be incorporated into the design and interpretation of future clinical trials involving patients with stage III melanoma.
AB - Purpose: To determine the survival rates and independent predictors of survival using a contemporary international cohort of patients with stage III melanoma. Patients and Methods: Complete clinicopathologic and follow-up data were available for 2,313 patients with stage III disease in an updated and expanded American Joint Committee on Cancer (AJCC) melanoma staging database. Kaplan-Meier and Cox multivariate survival analyses were performed. Results: Among all 2,313 patients with stage III disease, 81% had micrometastases, and 19% had clinically detectable macrometastases. The 5-year overall survival was 63%; it was 67% for patients with nodal micrometastases, and it was 43% for those with nodal macrometastases (P < .001). Tremendous heterogeneity in survival was observed, particularly in the microscopically detected nodal metastasis subset (from 23% to 87% for 5-year survival). Multivariate analysis demonstrated that in patients with nodal micrometastases, number of tumor-containing lymph nodes, primary tumor thickness, patient age, ulceration, and anatomic site of the primary independently predicted survival (all P < .01). When added to the model, primary tumor mitotic rate was the second-most powerful predictor of survival after the number of tumor-containing nodes. In contrast, for patients with nodal macrometastases, the number of tumor-containing nodes, primary ulceration, and patient age independently predicted survival (P < .01). Conclusion: In this multi-institutional analysis, we demonstrated remarkable heterogeneity of prognosis among patients with stage III melanoma, especially among those with nodal micrometastases. These results should be incorporated into the design and interpretation of future clinical trials involving patients with stage III melanoma.
UR - http://www.scopus.com/inward/record.url?scp=77952532215&partnerID=8YFLogxK
U2 - 10.1200/JCO.2009.27.1627
DO - 10.1200/JCO.2009.27.1627
M3 - Article
C2 - 20368546
AN - SCOPUS:77952532215
SN - 0732-183X
VL - 28
SP - 2452
EP - 2459
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 14
ER -