Prognostic Factors Analysis of 17,600 Melanoma Patients: Validation of the American Joint Committee on Cancer Melanoma Staging System

Author:

Balch Charles M.1,Soong Seng-Jaw1,Gershenwald Jeffrey E.1,Thompson John F.1,Reintgen Douglas S.1,Cascinelli Natale1,Urist Marshall1,McMasters Kelly M.1,Ross Merrick I.1,Kirkwood John M.1,Atkins Michael B.1,Thompson John A.1,Coit Daniel G.1,Byrd David1,Desmond Renee1,Zhang Yuting1,Liu Ping-Yu1,Lyman Gary H.1,Morabito Aberto1

Affiliation:

1. From the Johns Hopkins Medical Institutions, Baltimore, MD; American Society of Clinical Oncology, Alexandria, VA; University of Alabama at Birmingham, Birmingham, AL; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Sydney Melanoma Unit, University of Sydney, Sydney, New South Wales, Australia; H. Lee Moffit Cancer Center, University of South Florida, Tampa, FL; Istituto Nazionale Tumori, World Health Organization Melanoma Program, Milan, Italy; University of Louisville Medical Center,...

Abstract

PURPOSE: The American Joint Committee on Cancer (AJCC) recently proposed major revisions of the tumor-node-metastases (TNM) categories and stage groupings for cutaneous melanoma. Thirteen cancer centers and cancer cooperative groups contributed staging and survival data from a total of 30,450 melanoma patients from their databases in order to validate this staging proposal. PATIENTS AND METHODS: There were 17,600 melanoma patients with complete clinical, pathologic, and follow-up information. Factors predicting melanoma-specific survival rates were analyzed using the Cox proportional hazards regression model. Follow-up survival data for 5 years or longer were available for 73% of the patients. RESULTS: This analysis demonstrated that (1) in the T category, tumor thickness and ulceration were the most powerful predictors of survival, and the level of invasion had a significant impact only within the subgroup of thin (≤ 1 mm) melanomas; (2) in the N category, the following three independent factors were identified: the number of metastatic nodes, whether nodal metastases were clinically occult or clinically apparent, and the presence or absence of primary tumor ulceration; and (3) in the M category, nonvisceral metastases was associated with a better survival compared with visceral metastases. A marked diversity in the natural history of pathologic stage III melanoma was demonstrated by five-fold differences in 5-year survival rates for defined subgroups. This analysis also demonstrated that large and complex data sets could be used effectively to examine prognosis and survival outcome in melanoma patients. CONCLUSION: The results of this evidence-based methodology were incorporated into the AJCC melanoma staging as described in the companion publication.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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