Prolonged survival of 2 years or longer for patients with disseminated melanoma

Abstract

BACKGROUND.Once melanoma has metastasized to distant sites, the prognosis is during the period 1976-1996 at the Eberhard-Karls-University in Tuebingen, Germany. The attainment of 2 years' or longer survival time by patients with dissemin-1 Dermatological Clinic, Inselspital, Berne, Switated melanoma was addressed, and a multivariate analysis of related prognostic zerland.factors was performed by logistic regression. 2 Section of Dermatologic Oncology, Depart-RESULTS. Four hundred forty-two patients (13.6%) developed distant metastasis. ment of Dermatology, Eberhard-Karls-Univer-The median survival time was 7 months, and the 2-year, 5-year, and 10-year sursity, Tuebingen, Germany.vival rates were 11.9%, 6.7%, and 4.7%, respectively. Forty-five patients had prolonged survival of 2 years or longer. Significantly more females belonged to the group of long term survivors (P Å 0.0186). Of the modalities of therapy given, only surgery was associated with prolonged survival (P õ 0.0001). Primary metastasis to the skin (P Å 0.006), the brain (P Å 0.015), more than a single metastatic site (P Å 0.002), and Karnofsky performance status of less than 80 (P Å 0.0035) were significantly related to short term survival. In addition, subsequent development of two or more new metastatic sites was also associated with short term survival (P Å 0.0025). CONCLUSIONS.In the current analysis, prolonged survival of 2 years or longer for patients with disseminated melanoma was shown to depend on gender, site of primary metastasis, number of metastatic sites, and Karnofsky performance status.Of the modalities of therapy given, only surgery significantly influenced survival. However, in a small percentage of patients, long term complete remission was achieved with chemotherapy alone or in combination with surgery, suggesting that such regimens might be curative in selected cases.

Gender and other survival predictors in patients with metastatic melanoma on Southwest Oncology Group trials

“…Therefore, this database represents a powerful tool for the ascertainment of prognostic factors for survival after diagnosis of Stage IV disease. A review of the literature from the past 2 decades revealed 8 studies in which multivariate models (either by Cox regression, 11,12,3,7 logistic regression, 1,13,4 or Weibull survival regression 8 ) were used to evaluate prognostic factors for survival in metastatic melanoma (Table 5). This study was similar to the eight reviewed studies with respect to median survival, median age, percentage of male enrollment, and percentage of patients with visceral disease ( Table 5).…”

“…1,3,4,7,8 The Eastern Cooperative Oncology Group (ECOG) reviewed 635 patients with metastatic melanoma and found that female gender was a significant predictor of better survival. 7 Brand et al 1 analyzed 442 patients with distant metastatic disease. Females had a significantly higher probability of surviving 2 years than males.…”

“…1,4,7 Liver involvement and visceral involvement are correlated by definition (patients with liver involvement have visceral involvement). In this study, we separated patients with visceral involvement of the liver from those with other visceral involvement; both were highly significant indicators of worse survival.…”

“…Other studies have analyzed liver involvement in addition to visceral involvement and have found that one variable loses predictive power after adjustment for the other. 4,8 Both Barth et al 12 and Brand et al 1 grouped liver involvement with bone and brain involvement and found that this subset had the worst prognosis com- pared to other metastatic subsets. A higher number of organ sites with metastases was predictive of worse survival in several studies, 1,3,7,11 as was a shorter disease free interval.…”

“…Some studies have suggested that women with metastatic melanoma have better survival rates than men, [1][2][3][4][5][6][7][8][9] whereas other studies have found no differences in survival rates. 10 -14 At issue is whether the differences that were reported are due to discrepancies in other important prognostic factors for survival between the two populations.…”