Predicting recurrence in patients with sentinel node-negative melanoma: validation of the EORTC nomogram using population-based data

Author:

El Sharouni M A12ORCID,Ahmed T1,Witkamp A J3,Sigurdsson V2,van Gils C H4,Nieweg O E156,Scolyer R A1578ORCID,Thompson J F156ORCID,van Diest P J9,Lo S N15ORCID

Affiliation:

1. Melanoma Institute, The University of Sydney, Sydney, NSW, Australia

2. Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

3. Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

4. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands

5. Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

6. Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

7. Departments of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

8. New South Wales Health Pathology, Sydney, New South Wales, Australia

9. Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

Abstract

Abstract Background Identifying patients with sentinel node (SN)-negative melanoma who are at greatest risk of recurrence is important. The European Organization for Research and Treatment of Cancer (EORTC) Melanoma Group proposed a prognostic model that has not been validated in population-based data. The EORTC nomogram includes Breslow thickness, ulceration status and anatomical location as parameters. The aim of this study was to validate the EORTC model externally using a large national data set. Methods Adults with histologically proven, invasive cutaneous melanoma with a negative SN biopsy in the Netherlands between 2000 and 2014 were identified from the Dutch Pathology Registry, and relevant data were extracted. The EORTC nomogram was used to predict recurrence-free survival. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration. Results A total of 8795 patients met the eligibility criteria, of whom 14·7 per cent subsequently developed metastatic disease. Of these recurrences, 20·9 per cent occurred after the first 5 years of follow-up. Validation of the EORTC nomogram showed a C-statistic of 0·70 (95 per cent c.i. 0·68 to 0·71) for recurrence-free survival, with excellent calibration (R2 = 0·99; P = 0·999, Hosmer–Lemeshow test). Conclusion This population-based validation confirmed the value of the EORTC nomogram in predicting recurrence-free survival in patients with SN-negative melanoma. The EORTC nomogram could be used in clinical practice for personalizing follow-up and selecting high-risk patients for trials of adjuvant systemic therapy.

Funder

Research Fellowship

European Association of Dermatology and Venereology

Australian National Health and Medical Research Council Fellowship programme

Cancer Institute New South Wales

Australian National Health and Medical Research Council

MIA

Ainsworth Foundation

Cameron Family/Grant Broadcasters

Merck Sharp & Dohme

GlaxoSmithKline

Bristol-Myers Squibb

Novartis Pharmaceuticals Australia

GSK

Provectus

Publisher

Oxford University Press (OUP)

Subject

Surgery

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