Brenda Leeneman1, Margreet G Franken2, Veerle M H Coupé3, Mathijs P Hendriks4, Wim Kruit5, Peter W Plaisier6, Serge van Ruth7, José A M C Verstijnen8, Michel W J M Wouters9, Hedwig M Blommestein10, Carin A Uyl-de Groot2. 1. Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. Electronic address: leeneman@eshpm.eur.nl. 2. Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. 3. Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. 4. Department of Internal Medicine, Northwest Clinics - Alkmaar, PO Box 501, 1800 AM, Alkmaar, The Netherlands. 5. Department for Medical Oncology, Erasmus MC Cancer Institute, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. 6. Department of Surgical Oncology, Albert Schweitzer Hospital - Dordwijk, PO Box 444, 3300 AK, Dordrecht, The Netherlands. 7. Department of Dermatology, Tergooi - Hilversum, PO Box 10016, 1201 DA, Hilversum, The Netherlands. 8. Department of Internal Medicine, Amphia Hospital, PO Box 90157, 4800 RL, Breda, The Netherlands. 9. Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE, Amsterdam, The Netherlands. 10. Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands; Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands.
Abstract
OBJECTIVE: To investigate stage-specific survival from diagnosis, stage-specific disease recurrence, and post-recurrence survival in patients diagnosed with localized and regionally advanced cutaneous melanoma. METHODS: A retrospective, observational cohort study was conducted in six Dutch hospitals. We included patients with a first diagnosis of stage I, II, or III melanoma between January 2003 and December 2011. Descriptive statistics were used to summarize time to first recurrence and type of first recurrence. Overall survival (OS) from diagnosis and post-recurrence OS were assessed using the Kaplan-Meier method. RESULTS: A total of 3,093 patients had a first diagnosis of stage I (n = 2,299), II (n = 565), or III (n = 229) melanoma. Median OS was not yet reached for patients with stage I, 9.5 years for patients with stage II, and 6.8 years for patients with stage III. Fifty-seven patients (8%) with stage IB, 137 patients (29%) with stage II, and 81 patients (47%) with stage III developed disease recurrence. Median time to first recurrence was 2.8, 1.5, and 1.0 years for patients with stage IB, II, and III, respectively. Most patients (79%) developed regional lymph node or distant metastases as first recurrence. Median post-recurrence OS was 2.8, 3.9, and 0.5 years for patients with intralymphatic, regional lymph node, and distant metastases, respectively. CONCLUSION: A substantial number of patients developed disease recurrence. Of these patients, a considerably high proportion developed distant metastases which had a great impact on survival. Identifying disease recurrence at its earliest stage is crucial because metastatic melanoma remains incurable for most patients.
OBJECTIVE: To investigate stage-specific survival from diagnosis, stage-specific disease recurrence, and post-recurrence survival in patients diagnosed with localized and regionally advanced cutaneous melanoma. METHODS: A retrospective, observational cohort study was conducted in six Dutch hospitals. We included patients with a first diagnosis of stage I, II, or III melanoma between January 2003 and December 2011. Descriptive statistics were used to summarize time to first recurrence and type of first recurrence. Overall survival (OS) from diagnosis and post-recurrence OS were assessed using the Kaplan-Meier method. RESULTS: A total of 3,093 patients had a first diagnosis of stage I (n = 2,299), II (n = 565), or III (n = 229) melanoma. Median OS was not yet reached for patients with stage I, 9.5 years for patients with stage II, and 6.8 years for patients with stage III. Fifty-seven patients (8%) with stage IB, 137 patients (29%) with stage II, and 81 patients (47%) with stage III developed disease recurrence. Median time to first recurrence was 2.8, 1.5, and 1.0 years for patients with stage IB, II, and III, respectively. Most patients (79%) developed regional lymph node or distant metastases as first recurrence. Median post-recurrence OS was 2.8, 3.9, and 0.5 years for patients with intralymphatic, regional lymph node, and distant metastases, respectively. CONCLUSION: A substantial number of patients developed disease recurrence. Of these patients, a considerably high proportion developed distant metastases which had a great impact on survival. Identifying disease recurrence at its earliest stage is crucial because metastatic melanoma remains incurable for most patients.