Regression is significantly associated with outcomes for patients with melanoma

Subramanian, Sarayu; Han, Gang; Olson, Nancy Y.; Leong, Stanley P. L.; Kashani‐Sabet, Mohammed; White, Richard L.; Zager, Jonathan S.; Sondak, Vernon K.; Messina, Jane L.; Pockaj, Barbara A.; Kosiorek, Heidi E.; Vetto, John T.; Fowler, Graham; Schneebaum, Schlomo; Han, Dale

doi:10.1016/j.surg.2021.05.010

Cited by 10 publications

(10 citation statements)

References 30 publications

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“…Furthermore, regression had a significant protective role for patients even after accounting for other variables in the multivariate model analysis 47 . This protective factor could be related to the early activation of immunologic system against the primary tumor cells, limiting the growth and spread of melanoma 45,48 …”

Section: Discussionmentioning

confidence: 99%

“…Individuals with regression exhibit a lower risk of sentinel lymph node metastasis and mortality compared with those without regression. 45,46 In a survival analysis conducted on patients with stage I-II cutaneous melanoma, those with tumor regression displayed better survival rates in terms of both DFS and overall survival when compared with patients without regression.…”

Section: Discussionmentioning

confidence: 99%

“…47 This protective factor could be related to the early activation of immunologic system against the primary tumor cells, limiting the growth and spread of melanoma. 45,48 One of the strengths of this study is that we focused solely on stage I-II AM, which limited the prognostic impact of delayed…”

Section: Discussionmentioning

confidence: 99%

“…Although the tumor regression status did not influence the DFS in our study, previous research has demonstrated that tumor regression serves as a protective factor in melanoma patients. Individuals with regression exhibit a lower risk of sentinel lymph node metastasis and mortality compared with those without regression 45,46 . In a survival analysis conducted on patients with stage I‐II cutaneous melanoma, those with tumor regression displayed better survival rates in terms of both DFS and overall survival when compared with patients without regression.…”

Section: Discussionmentioning

confidence: 99%

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Impact of clinical and histopathological characteristics on the disease‐free survival of stage I‐II acral melanoma patients

Borges de Barros Primo,

Brito Nobre,

Santos

et al. 2023

Int J Dermatology

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BackgroundAcral melanoma is rare and associated with a worse prognosis compared to cutaneous melanoma in other locations. Despite this, few studies have focused on the prognosis of acral melanoma, particularly in patients with initial clinical stage. The aim of this study was to assess the impact of clinical and histopathological characteristics on the disease‐free survival (DFS) of stage I‐II patients.MethodsWe analyzed 154 stage I‐II acral melanoma cases, all of whom underwent a review of the histopathological and clinical parameters. Patients were divided into groups based on the presence or absence of disease recurrence within 5 years. We used Cox proportional regression to analyze independent risk factors and computed DFS curves using the Kaplan–Meier method.ResultsWithin 5 years, 27.9% of patients experienced disease recurrence, with 90.4% occurring during the first 3 years. Univariate and multivariate analyses did not identify any clinical parameters with a significant influence on DFS. The DFS rate at 5 years was 72.7%. The median duration of disease recurrence after the initial diagnosis was 21 months. However, Breslow thickness, presence of ulceration, >3 mitosis/mm2, presence of tumor‐infiltrating lymphocytes (TIL), and perineural invasion were significantly associated with a decrease in time to first recurrence.ConclusionsDespite the favorable prognosis of stage I‐II acral melanoma compared with advance stage, clinical and histopathological characteristics can impact prognosis. In addition to Breslow thickness and ulceration, attention should be paid to mitotic rate, presence of TIL, and perineural invasion to optimize follow‐up of acral melanoma patients diagnosed in the initial clinical stage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of clinical and histopathological characteristics on the disease‐free survival of stage I‐II acral melanoma patients

Borges de Barros Primo,

Brito Nobre,

Santos

et al. 2023

Int J Dermatology

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“…However, the patient's age and sex and other primary tumor features may also have important prognostic implications; their collection and documentation has been recommended by the AJCC-8 melanoma expert panel. 7,13,14 These include tumor mitotic rate (TMR), [15][16][17][18][19] presence of tumor infiltrating lymphocytes (TILs), 20 presence of regression, 21,22 presence of lymphovascular invasion (LVI), 22 melanoma subtype, 23,24 and body site. 25 The degree to which each of these additional variables may be independently prognostically significant remains to be determined, particularly for outcomes other than MSS.…”

Section: Introductionmentioning

confidence: 99%

Predicting Recurrence-Free and Overall Survival for Patients With Stage II Melanoma: The MIA Calculator

Varey,

Li,

El Sharouni

et al. 2024

JCO

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PURPOSE Improvements in recurrence-free survival (RFS) were demonstrated in two recent randomized trials for patients with sentinel node (SN)–negative stage IIB or IIC melanoma receiving adjuvant systemic therapy (pembrolizumab/nivolumab). However, adverse events also occurred. Accurate individualized prognostic estimates of RFS and overall survival (OS) would allow patients to more accurately weigh the risks and benefits of adjuvant therapy. Since the current American Joint Committee on Cancer eighth edition (AJCC-8) melanoma staging system focuses on melanoma-specific survival, we developed a multivariable risk prediction calculator that provides estimates of 5- and 10-year RFS and OS for these patients. METHODS Data were extracted from the Melanoma Institute Australia (MIA) database for patients diagnosed with stage II (clinical or pathological) melanoma (n = 3,220). Survival prediction models were developed using multivariable Cox regression analyses (MIA models) and externally validated twice using data sets from the United States and the Netherlands. Each model's performance was assessed using C-statistics and calibration plots and compared with Cox models on the basis of AJCC-8 staging (stage models). RESULTS The 5-year and 10-year RFS C-statistics were 0.70 and 0.73 (MIA-model) versus 0.61 and 0.60 (stage-model), respectively. For OS, the 5-year and 10-year C-statistics were 0.71 and 0.75 (MIA-model) compared with 0.62 and 0.61 (stage-model), respectively. The MIA models were well calibrated and externally validated. CONCLUSION The MIA models offer accurate and personalized estimates of both RFS and OS in patients with stage II melanoma even in the absence of pathological staging with SN biopsy. These models were robust on external validations and may be used in everyday practice both with (ideally) and without performing SN biopsy to identify high-risk patients for further management strategies. An online tool will be available at the MIA website (Risk Prediction Tools).

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Regression in melanoma is significantly associated with a lower regional recurrence rate and better recurrence‐free survival

Subramanian

Han

Olson

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: The prognostic significance of regression in predicting melanoma recurrences is unknown. We present a large multicenter study correlating regression with recurrence. Methods:The Sentinel Lymph Node Working Group database was queried from 1993 to 2018 for cases with regression data. Clinicopathologic factors were correlated with overall and first-site of recurrence and with recurrence-free survi- val (RFS).Results: There were 4790 patients and the median follow-up was 39.6 months.Regression and recurrences were seen in 1081 (22.6%) and 773 (16.1%) cases, respectively. First-site locoregional and distant recurrences were seen in 412 (8.6%) and 352 (7.3%) patients, respectively. Regression was seen in 15.8% and 24.7% of all cases with and without recurrences (p < 0.0001), respectively, while regression was seen in 14.3% and 17.9% of first-site locoregional and distant recurrent cases, respectively, compared with 23.3% and 22.9% of patients with regression and without first-site locoregional and distant recurrences, respectively (p = 0.29). On multivariable analysis, after controlling for age, gender, thickness, ulceration, lymphovascular invasion, and sentinel lymph node status, regression significantly predicted improved RFS (p = 0.004) and fewer first-site regional recurrences (p = 0.017). Conclusion:Our data suggest that regression is a favorable prognostic marker in melanoma and predicts significantly better RFS and decreased first-site regional recurrences.

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Regression is significantly associated with outcomes for patients with melanoma

Cited by 10 publications

References 30 publications

Impact of clinical and histopathological characteristics on the disease‐free survival of stage I‐II acral melanoma patients

Impact of clinical and histopathological characteristics on the disease‐free survival of stage I‐II acral melanoma patients

Predicting Recurrence-Free and Overall Survival for Patients With Stage II Melanoma: The MIA Calculator

Regression in melanoma is significantly associated with a lower regional recurrence rate and better recurrence‐free survival

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