Mary-Ann El Sharouni1,2, Karina Aivazian1,3, Arjen J Witkamp4, Vigfús Sigurdsson2, Carla H van Gils5, Richard A Scolyer1,3,6, John F Thompson1,3,7, Paul J van Diest8, Serigne N Lo1,6. 1. Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia. 2. Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 3. Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia. 4. Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 5. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands. 6. Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. 7. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 8. Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Abstract
Importance: Although regression is commonly observed in cutaneous melanoma, it is uncertain whether it is associated with patient prognosis. Objective: To determine whether histologically confirmed regression was associated with better or worse survival in patients with primary cutaneous melanoma. Design, Setting, and Participants: This cohort study analyzed data from 2 large cohorts of adults (one in the Netherlands and the other in Australia) with histologically proven, stage 1 and 2 primary, invasive cutaneous melanoma with known regression status treated between 2000 and 2014, with median follow-up times of 4.5 and 11.1 years for the Dutch and Australian cohorts, respectively. For the Dutch patients, population-based data from PALGA, the Dutch Pathology Registry, were used, and follow-up data were retrieved from the Netherlands Cancer Registry. For the Australian patients, data from the database of a large, specialized melanoma treatment center were used. Main Outcomes and Measures: Multivariable Cox proportional hazards analyses were performed per cohort to assess recurrence-free survival (RFS) and overall survival (OS), and subgroup analyses according to Breslow thickness category and melanoma subtype were performed. Results: A total of 17 271 Dutch patients and 4980 Australian patients were included. In both cohorts, survival outcomes were better for patients with disease regression. For Dutch patients, the hazard ratio (HR) for those with disease regression was 0.55 (95% CI, 0.48-0.63; P < .001) for RFS and 0.87 (95% CI, 0.79-0.96; P = .004) for OS; for the Australian patients, the HR was 0.61 (95% CI, 0.52-0.72; P < .001) for RFS and 0.73 (95% CI, 0.64-0.84; P < .001) for OS. Subgroup analyses showed that the presence of regression improved RFS within thin and intermediate Breslow thickness melanomas in both cohorts. For patients with superficial spreading melanoma (SSM) subtype, regression improved RFS and OS in both cohorts. For Dutch patients with SSM, the HR for those with disease regression was 0.54 (95% CI, 0.46-0.63; P < .001) for RFS and 0.86 (95% CI, 0.76-0.96; P = .009) for OS; for the Australian patients with SSM, the HR was 0.67 (95% CI, 0.52-0.85; P = .001) for RFS and 0.72 (95% CI, 0.59-0.88; P = .001) for OS. Conclusions and Relevance: In 2 large patient cohorts from 2 different continents, regression was a favorable prognostic factor for patients with stage 1 and 2 melanomas, especially in those with thin and intermediate thickness tumors and those with SSM subtype.
Importance: Although regression is commonly observed in cutaneous melanoma, it is uncertain whether it is associated with patient prognosis. Objective: To determine whether histologically confirmed regression was associated with better or worse survival in patients with primary cutaneous melanoma. Design, Setting, and Participants: This cohort study analyzed data from 2 large cohorts of adults (one in the Netherlands and the other in Australia) with histologically proven, stage 1 and 2 primary, invasive cutaneous melanoma with known regression status treated between 2000 and 2014, with median follow-up times of 4.5 and 11.1 years for the Dutch and Australian cohorts, respectively. For the Dutch patients, population-based data from PALGA, the Dutch Pathology Registry, were used, and follow-up data were retrieved from the Netherlands Cancer Registry. For the Australian patients, data from the database of a large, specialized melanoma treatment center were used. Main Outcomes and Measures: Multivariable Cox proportional hazards analyses were performed per cohort to assess recurrence-free survival (RFS) and overall survival (OS), and subgroup analyses according to Breslow thickness category and melanoma subtype were performed. Results: A total of 17 271 Dutch patients and 4980 Australian patients were included. In both cohorts, survival outcomes were better for patients with disease regression. For Dutch patients, the hazard ratio (HR) for those with disease regression was 0.55 (95% CI, 0.48-0.63; P < .001) for RFS and 0.87 (95% CI, 0.79-0.96; P = .004) for OS; for the Australian patients, the HR was 0.61 (95% CI, 0.52-0.72; P < .001) for RFS and 0.73 (95% CI, 0.64-0.84; P < .001) for OS. Subgroup analyses showed that the presence of regression improved RFS within thin and intermediate Breslow thickness melanomas in both cohorts. For patients with superficial spreading melanoma (SSM) subtype, regression improved RFS and OS in both cohorts. For Dutch patients with SSM, the HR for those with disease regression was 0.54 (95% CI, 0.46-0.63; P < .001) for RFS and 0.86 (95% CI, 0.76-0.96; P = .009) for OS; for the Australian patients with SSM, the HR was 0.67 (95% CI, 0.52-0.85; P = .001) for RFS and 0.72 (95% CI, 0.59-0.88; P = .001) for OS. Conclusions and Relevance: In 2 large patient cohorts from 2 different continents, regression was a favorable prognostic factor for patients with stage 1 and 2 melanomas, especially in those with thin and intermediate thickness tumors and those with SSM subtype.
Authors: Sam Polesie; Lisa Sundback; Martin Gillstedt; Hannah Ceder; Johan Dahlén Gyllencreutz; Julia Fougelberg; Eva Johansson Backman; Jenna Pakka; Oscar Zaar; John Paoli Journal: Acta Derm Venereol Date: 2021-10-14 Impact factor: 3.875
Authors: Laura A Taylor; Megan M Eguchi; Lisa M Reisch; Andrea C Radick; Hannah Shucard; Kathleen F Kerr; Michael W Piepkorn; Stevan R Knezevich; David E Elder; Raymond L Barnhill; Joann G Elmore Journal: Cancer Date: 2021-05-04 Impact factor: 6.860
Authors: Steven Morrison; Gang Han; Faith Elenwa; John T Vetto; Graham Fowler; Stanley P Leong; Mohammed Kashani-Sabet; Barbara Pockaj; Heidi E Kosiorek; Jonathan S Zager; Jane L Messina; Nicola Mozzillo; Schlomo Schneebaum; Dale Han Journal: Ann Surg Oncol Date: 2022-01-21 Impact factor: 5.344