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

Balch, Charles M., Soong, Seng-Jaw, Gershenwald, Jeffrey E., Thompson, John F., Reintgen, Douglas S., Cascinelli, Natale, Urist, Marshall, McMasters, Kelly M., Ross, Merrick I., Kirkwood, John M., Atkins, Michael B., Thompson, John A., Coit, Daniel G., Byrd, David, Desmond, Renee, Zhang, Yuting, Liu, Ping-Yu, Lyman, Gary H., Morabito, Aberto·2001·Journal of Clinical Oncology
DOI 10.1200/jco.2001.19.16.3622
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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.

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Authors
Balch, C. M., Soong, S.-J., Gershenwald, J. E., Thompson, J. F., Reintgen, D. S., Cascinelli, N., Urist, M., McMasters, K. M., Ross, M. I., Kirkwood, J. M., Atkins, M. B., Thompson, J. A., Coit, D. G., Byrd, D., Desmond, R., Zhang, Y., Liu, P.-Y., Lyman, G. H., & Morabito, A.
Venue
Journal of Clinical Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2001-08-15
Volume
19
Issue
16
Pages
3622-3634
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
DOI
10.1200/jco.2001.19.16.3622
OpenAlex
W1951046932
Cited by
2,388
References
0
FWCI
36.09
Type
journal article
Language
en
Open access
closed

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