Andrea Maurichi1, Rosalba Miceli2, Tiziana Camerini2, Luigi Mariani2, Roberto Patuzzo2, Roberta Ruggeri2, Gianfranco Gallino2, Elena Tolomio2, Gabrina Tragni2, Barbara Valeri2, Andrea Anichini2, Roberta Mortarini2, Daniele Moglia2, Giovanni Pellacani2, Sara Bassoli2, Caterina Longo2, Pietro Quaglino2, Nicola Pimpinelli2, Lorenzo Borgognoni2, Daniele Bergamaschi2, Catherine Harwood2, Odysseas Zoras2, Mario Santinami2. 1. 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, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece. andrea.maurichi@istitutotumori.mi.it. 2. 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, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece.
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.
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.
Authors: Zachary Hothem; Andrew Bayci; Bryan J Thibodeau; Billie E Ketelsen; Laura E Fortier; Alison F Uzieblo; Diane Cosner; Kristin Totoraitis; Richard D Keidan; George D Wilson Journal: Mol Cell Oncol Date: 2016-11-08
Authors: A Piñero-Madrona; G Ruiz-Merino; P Cerezuela Fuentes; E Martínez-Barba; J N Rodríguez-López; J Cabezas-Herrera Journal: Clin Transl Oncol Date: 2019-02-19 Impact factor: 3.405
Authors: Clio Dessinioti; Niki Dimou; Alan C Geller; Aravella Stergiopoulou; Serigne Lo; Ulrike Keim; Jeffrey E Gershenwald; Lauren E Haydu; Simone Ribero; Pietro Quaglino; Susana Puig; Josep Malvehy; Lidija Kandolf-Sekulovic; Tatjana Radevic; Roland Kaufmann; Laura Meister; Eduardo Nagore; Victor Traves; Grigorios G Champsas; Mihaela Plaka; Brigitte Dreno; Emilie Varey; David Moreno Ramirez; Reinhard Dummer; Joanna Mangana; Axel Hauschild; Friederike Egberts; Ketty Peris; Laura Del Regno; Ana-Maria Forsea; Sabina A Zurac; Ricardo Vieira; Ana Brinca; Iris Zalaudek; Teresa Deinlein; Eleni Linos; Evangelos Evangelou; John F Thompson; Richard A Scolyer; Claus Garbe; Alexander J Stratigos Journal: J Natl Cancer Inst Date: 2019-12-01 Impact factor: 13.506
Authors: Andrew J Sinnamon; Madalyn G Neuwirth; Pratyusha Yalamanchi; Phyllis Gimotty; David E Elder; Xiaowei Xu; Rachel R Kelz; Robert E Roses; Emily Y Chu; Michael E Ming; Douglas L Fraker; Giorgos C Karakousis Journal: JAMA Dermatol Date: 2017-09-01 Impact factor: 10.282