Nomograms to predict recurrence and survival in stage IIIB and IIIC melanoma after therapeutic lymphadenectomy

Kiarash Khosrotehrani; Augustinus P T van der Ploeg; Victor Siskind; Maria Celia Hughes; Annaliesa Wright; Janine Thomas; Andrew Barbour; Christopher Allan; Gerard Bayley; Alexander Eggermont; Cornelis Verhoef; B Mark Smithers; Adele C Green

doi:10.1016/j.ejca.2014.02.010

Nomograms to predict recurrence and survival in stage IIIB and IIIC melanoma after therapeutic lymphadenectomy

Eur J Cancer. 2014 May;50(7):1301-9. doi: 10.1016/j.ejca.2014.02.010. Epub 2014 Mar 6.

Affiliations

¹ The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia; The University of Queensland, UQ Diamantina Institute, Translational Research Institute, Woolloongabba, QLD, Australia. Electronic address: k.khosrotehrani@uq.edu.au.
² Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
³ QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia.
⁴ The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia.
⁵ Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
⁶ Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Institut de Cancérologie Gustave Roussy, Villejuif-Paris, France.
⁷ QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.

PMID: 24613127
DOI: 10.1016/j.ejca.2014.02.010

Abstract

Background: Current staging algorithms in melanoma patients undergoing therapeutic lymph node dissection (LND) fail to accurately distinguish long-term survivors from those at risk of rapid relapse. Our goal was to establish and validate nomograms for predicting both recurrence and survival after LND.

Methods: A prospective cohort of stage IIIB and IIIC melanoma patients was ascertained from a tertiary hospital in Brisbane, Australia. Failure-time multivariate analysis identified key factors that, in adjusted combinations, generated nomograms to predict 2-year recurrence and 5-year melanoma-specific survival. The predictive value of these nomograms was further validated in a patient cohort from Rotterdam, The Netherlands.

Results: In 494 Australian patients, number of positive lymph nodes, extra-capsular extension and nodular histopathological subtype were the main independent predictors of 2-year recurrence while age, number of positive nodes and extra-capsular extension were the independent predictors of survival. Predictive value was confirmed in The Netherlands cohort of 331 patients. The nomograms were able to classify patients according to their 2-year recurrence and 5-year survival rates even within each stage III sub-class.

Conclusions: Models that include extra-capsular extension predict outcomes in patients with clinically involved lymph nodes. This tool may help tailor treatment and monitoring of this group of patients.

Keywords: Melanoma; Metastasis; Nomogram; Prognosis; lymph.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Decision Support Techniques*
Female
Humans
Lymph Node Excision*
Male
Melanoma / mortality
Melanoma / pathology
Melanoma / surgery*
Middle Aged
Neoplasm Recurrence, Local*
Netherlands / epidemiology
Nomograms*
Predictive Value of Tests
Prospective Studies
Queensland / epidemiology
Skin Neoplasms / mortality
Skin Neoplasms / pathology
Skin Neoplasms / surgery*
Survival Analysis