Model Predicting Survival in Stage I Melanoma Based on Tumor Progression

Abstract

We used the lesional steps in tumor progression and multivariable logistic regression to develop a prognostic model for primary, clinical stage I cutaneous melanoma. This model is 89% accurate in predicting survival. Using histologic criteria, we assigned melanomas to tumor progression steps by ascertaining their particular growth phase. These phases were the in situ and invasive radial growth phase and the vertical growth phase (the focal formation of a dermal tumor nodule or dermal tumor plaque within the radial growth phase or such dermal growth without an evident radial growth phase). After a minimum follow-up of 100.6 months and a median follow-up of 150.2 months, 122 invasive radial-growth-phase tumors were found to be without metastases. Eight-year survival among the 264 patients whose tumors had entered the vertical growth phase was 71.2%. Survival prediction in these patients was enhanced by the use of a multivariable logistic regression model. Twenty-three attributes were tested for entry into this model. Six had independently predictive prognostic information: (a) mitotic rate per square millimeter, (b) tumor-infiltrating lymphocytes, (c) tumor thickness, (d) anatomic site of primary melanoma, (e) sex of the patient, and (f) histologic regression. When mitotic rate per square millimeter, tumor-infiltrating lymphocytes, primary site, sex, and histologic regression are added to a logistic regression model containing tumor thickness alone, they are independent predictors of 8-year survival (P less than .0005).

Intratumoral neutrophils and plasmacytoid dendritic cells indicate poor prognosis and are associated with pSTAT3 expression in AJCC stage I/II melanoma

“…CD8þ lymphocyte infiltration grading was based on the criteria established by Clark et al 22 Lymphocyte response: lymphocytes surround or infiltrate TN in the tumor vertical growth phase (VGP) was categorized as brisk if the lymphocytes diffusely infiltrated the whole VGP or the whole base of the tumor. The term nonbrisk was used, when infiltration was only seen focally, and the lymphocytes were categorized as absent when no lymphocytes infiltrated the VGP.…”

Targeting tumors with LIGHT to generate metastasis-clearing immunity

“…Even with immune recognition of cancer, which can occur in cancer patients and is evidenced by the frequent observation of T cell infiltration into cancerous tissues [70][71][72][73], it is rare for such tumor infiltrating T cells to induce the spontaneous rejection of established tumors. Accumulating evidence indicates that the tumor environment contains cells and cytokines that actively suppress primed effector T cells [74,75].…”

Prognostic instrument for survival outcome in melanoma patients: based on data from the population-based Swedish Melanoma Register

“…(1) Mervic suggests that adding sex, age and tumour site to the AJCCclassification could improve the prediction of an individual patient's prognosis compared to the AJCC staging system currently in use (1,2). A few prognostic instruments have been presented but some are based on a limited number of patients and others are based on selected groups of patients referred to major institutions treating CMM (3)(4)(5)(6)(7)(8)(9). Hence, former instruments have not been as generalizable as expected.…”