Cost‐effectiveness analysis of imaging strategy for an intensive follow‐up of patients with American Joint Committee on Cancer stage
            <scp>IIB</scp>
            ,
            <scp>IIC</scp>
            and
            <scp>III</scp>
            malignant melanoma

Podlipnik, Sebastián; Moreno‐Ramírez, D.; Carrera, Cristina; Barreiro, Álvaro; Manubens, E.; Ferrandiz‐Pulido, L.; Sánchez, Marcelo; Vidal-Sicart, Sergi; Malvehy, Josep; Puig, Susana

doi:10.1111/bjd.16833

Cited by 25 publications

(19 citation statements)

References 25 publications

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“…A main focus of discussion is whether surveillance CT will actually detect recurrences in a meaningful proportion of asymptomatic patients before those patients might prompt work‐up and detection by their provider. The detection of recurrences by surveillance CT scans has been reported to be between 24% and 59% when reviewing late stage II and stage III disease . Several more recent studies found that CT scans first detect at least half of systemic recurrences .…”

Section: Surveillance Modalitiesmentioning

confidence: 99%

“…This ranges to nearly 8% for a 20‐year old female patient when receiving a PET/CT every 6 months for 10 years . Although costly, Podlipnik et al concluded recently that 6‐monthly surveillance CT scans were cost‐effective in stages IIB, IIC, and III patients for the first 3 years after diagnosis. Of note, although uncommon, curable secondary malignancies may be incidentally discovered (reported 6% in a melanoma surveillance series with PET) during posttreatment serial imaging, which is an ancillary benefit …”

Section: Surveillance Modalitiesmentioning

confidence: 99%

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Follow‐up of the melanoma patient

Deschner

Wayne

2018

Journal of Surgical Oncology

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Follow‐up of the melanoma patient involves many different methods of surveillance. Specific guidelines for modalities and frequency are flexible and largely open to physician preference. Patient education and self‐examination are generally viewed as crucial and cost‐effective for recurrence detection. Increased frequency of clinical follow‐up, laboratory studies, and imaging has not demonstrated survival benefit in surveillance. However, appropriate application of these different methods is controversial and evolving, especially with changing surgical management and new medical therapies.

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Section: Surveillance Modalitiesmentioning

confidence: 99%

Section: Surveillance Modalitiesmentioning

confidence: 99%

Follow‐up of the melanoma patient

Deschner

Wayne

2018

Journal of Surgical Oncology

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“…[2][3][4] After the diagnosis of a primary melanoma, patients are enrolled in follow-up schedules depending on their risk of relapse, but due to its increasing prevalence, the workload and costs of surveillance programs have increased markedly. [5][6][7][8] Many surveillance strategies have been proposed, mainly based on initial AJCC clinical-pathological staging; [9][10][11] nevertheless, there are still many 'low-risk' melanoma patients who suffer relapses, resulting in high mortality. 9 In addition, approximately two thirds of patients whose melanoma will metastasize leading to death were initially sentinel lymph node biopsy (SLNB) negative (American Joint Committee on Cancer [AJCC] stages I and II).…”

Section: Introductionmentioning

confidence: 99%

Early outcome of a 31‐gene expression profile test in 86 AJCC stage IB‐II melanoma patients. A prospective multicentre cohort study

Podlipnik

Carrera

Boada

et al. 2019

Acad Dermatol Venereol

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Background The clinical and pathological features of primary melanoma are not sufficiently sensitive to accurately predict which patients are at a greater risk of relapse. Recently, a 31‐gene expression profile (DecisionDx‐Melanoma) test has shown promising results. Objectives To evaluate the early prognostic performance of a genetic signature in a multicentre prospectively evaluated cohort. Methods Inclusion of patients with AJCC stages IB and II conducted between April 2015 and December 2016. All patients were followed up prospectively to assess their risk of relapse. Prognostic performance of this test was evaluated individually and later combined with the AJCC staging system. Prognostic accuracy of disease‐free survival was determined using Kaplan–Meier curves and Cox regression analysis. Results of the gene expression profile test were designated as Class 1 (low risk) and Class 2 (high risk). Results Median follow‐up time was 26 months ( IQR 22–30). The gene expression profile test was performed with 86 patients; seven had developed metastasis (8.1%) and all of them were in the Class 2 group, representing 21.2% of this group. Gene expression profile was an independent prognostic factor for relapse as indicated by multivariate Cox regression analysis, adjusted for AJCC stages and age. Conclusions This prospective multicentre cohort study, performed in a Spanish Caucasian cohort, shows that this 31‐gene expression profile test could correctly identify patients at early AJCC stages who are at greater risk of relapse. We believe that gene expression profile in combination with the AJCC staging system could well improve the detection of patients who need intensive surveillance and optimize follow‐up strategies.

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“…Sentinel lymph node biopsy and follow‐up protocols were carried out according to the institution's guidelines . Overall survival (OS) time was calculated from the date of diagnosis of the primary melanoma to the date of death by any cause or last follow‐up visit.…”

Section: Methodsmentioning

confidence: 99%

“…Sentinel lymph node biopsy and follow-up protocols were carried out according to the institution's guidelines. 26,27 Overall survival (OS) time was calculated from the date of diagnosis of the primary melanoma to the date of death by any cause or last follow-up visit. Melanoma-specific survival (MSS) was calculated from the time of diagnosis of the primary melanoma to the time of death by melanoma or the last followup visit.…”

Section: Cohort Descriptionmentioning

confidence: 99%

Inherited MC 1R variants in patients with melanoma are associated with better survival in women

et al. 2019

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Summary Background Women have a better melanoma prognosis, and fairer skin/hair colour. The presence of inherited MC1R variants has been associated with a better melanoma prognosis, but its interaction with sex is unknown. Objectives To evaluate the relationship between germline MC1R status and survival, and determine any association with sex. Methods This was a cohort study including 1341 patients with melanoma from the Melanoma Unit of the Hospital Clinic of Barcelona, between January 1996 and April 2018. We examined known sex‐related prognosis factors as they relate to features of melanoma and evaluated the sex‐specific role of MC1R in overall and melanoma‐specific survival. Hazard ratios (HRs) were calculated using univariate and multivariate Cox logistic regression. Results Men showed lower overall survival than women (P < 0·001) and the presence of inherited MC1R variants was not associated with better survival in our cohort. However, in women the presence of MC1R variants was associated with better overall survival in the multivariate analysis [HR 0·57, 95% confidence interval (CI) 0·38–0·85; P = 0·006] but not in men [HR 1·26, 95% CI 0·89–1·79; P = 0·185 (P‐value for interaction 0·004)]. Analysis performed for melanoma‐specific survival showed the same level of significance. Conclusions Inherited MC1R variants are associated with improved overall survival in women with melanoma but not in men. Intrinsic sex‐dependent features can modify the role of specific genes in melanoma prognosis. We believe that survival studies of patients with melanoma should include analysis by sex and MC1R genotype. What's already known about this topic? Inherited MC1R variants have been associated with a better melanoma prognosis, but their interaction with sex is unknown. What does this study add? MC1R variants are related to better overall survival and melanoma‐specific survival in women but not in men. What is the translational message? These differences between the sexes could imply future changes in melanoma follow‐up and treatment strategies. This provides a basis for understanding the interaction between sex‐related genes and germline variants in cancer.

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Cost‐effectiveness analysis of imaging strategy for an intensive follow‐up of patients with American Joint Committee on Cancer stage IIB , IIC and III malignant melanoma

Cited by 25 publications

References 25 publications

Follow‐up of the melanoma patient

Follow‐up of the melanoma patient

Early outcome of a 31‐gene expression profile test in 86 AJCC stage IB‐II melanoma patients. A prospective multicentre cohort study

Inherited MC 1R variants in patients with melanoma are associated with better survival in women

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