Improved methodology in determining melanoma mortality and selecting patients for immunotherapy

Abstract

Improved methodology in determining melanoma mortality and selecting patients for immunotherapyDear Editor, Sentinel lymph node biopsy (SLNB) benefits are said to include identifying the presence and degree of micrometastases, improving staging, predicting prognosis and determining eligibility for adjuvant drug therapy. Sentinel lymph node biopsy is an invasive procedure, which needs nuclear medicine and operating room facilities. Neither SLNB nor early identification of micrometastases provides an overall survival benefit for melanoma patients. 1,2 Adverse events in the order of 11% are expected. 3 Predicting the likelihood of mortality can assist patient selection for adjuvant drug therapy. Breslow thickness, ulceration status and other clinical and pathologic predictors (CAPP) assist predicting melanoma survival. 4 Sentinel lymph node biopsy status (SLNBS) might contribute only a marginal survival predictability above that of an algorithm of CAPP. 5,6 Until recently, no quality research has been available to test this hypothesis.El Sharouni et al (ESS) 7 recently detailed the prognostic value of CAPP, with or without SLNBS, for calculating overall survival (OS) for melanoma patients. Predictors including Breslow thickness, tumour, ulceration, patient age, sex, mitotic activity, regression, tumour subtype and location were evaluated in 9272 Dutch patients. The findings were validated in 5644 Australian patients. 7 El Sharouni et al evaluated the accuracy of each CAPP in predicting OS using appropriate Area Under Curve (AUC) cstatistic methodology. 7 The higher the C-statistic, the better the model separates patients who will die from those who will not die. Combined CAPP was significantly superior to SLNBS at predicting OS. Combining SLNBS with CAPP increased c-statistic for OS by only 3%, with overlapping confidence intervals indicating an absence of statistical significance (Figure 1).El Sharouni et al found Breslow thickness to be the most accurate OS predictor followed by patient age. Subsequently, SLNBS and ulceration were similar. Mitotic activity and regression fell below 0.54, suggesting they might not provide relevant information 7 (Figure 2).El Sharouni et al also reported that SLNBS detected 1.4 more net high-risk melanoma patients (HRMP) for every 100 patients experiencing recurrence within 3 years when used in combination with CAPP. 7 Recurrence rates of approximately 13%-15% have been reported in HRMP. 8 Assuming

Sentinel lymph node biopsy is unreliable in predicting melanoma mortality for both younger and older patients

“…For older patients, the BAUSSS biomarker provides superior mortality prediction than SLNB and hence the potential for benefit from ADT. 13 This concern extends to 60 to 79-year-old patients with melanoma over 1 mm thickness. Gene profiling is emerging as a further prognostic tool to assist refining which melanoma patients are at high-risk.…”

Online tools for predicting melanoma survival: Including sentinel node status as a variable improves prediction accuracy

“…Serigne N. Lo 1,2 Alexander H. R. Varey 1,2,3 Mary-Ann El Sharouni 1,4 Richard A. Scolyer 1,2,5,6 John F. Thompson 1,2,7,8 of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia 6 Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia…”

“…Online tools for predicting melanoma survival: Including sentinel node status as a variable improves prediction accuracy Dear Editor, Three online tools for predicting survival for patients with primary cutaneous melanomas were compared in a recent report. 1 However, the conclusion that the LifeM ath. net prediction tool, which does not consider sentinel node (SN) status, was the most reliable appears to have been based on inappropriate statistical methodology.…”

Online prediction tools for melanoma survival: A comparison

“…These results confirm tumour thickness as the single most important survival predictor for melanoma. We have previously identified that Breslow thickness, age and ulceration (BAU) are substantially more accurate than SLNB status at predicting survival outcomes 2 . BAU is likely sufficient for clinical usage in counselling individual patients on their melanoma survival prospects.…”