Learning objectives
Prognostic patterns of recurrence in Stage III Melanoma
Background
Melanoma is the 3rd overall most common cancer in Australia (excluding non-melanoma skin cancer),
with the second highest incidence of Melanoma of the skin cancer in the world.[1]
Even after curative treatment,
risk of relapse for stage III melanoma is high[2].
Early detection is key in precipitating early intervention for low volume disease,
allowing for improved survival outcomes[3,4].
Despite this,
there is limited published data to guide an overall consensus for follow-up strategies with stage III melanoma,
and guideliens have largely been empirical[5].
We study...
Imaging findings OR Procedure details
Figure 1.
Most recurrences (49%) occurred within the first two years after resection.
There was a significant drop off in the rate of progression of disease after this time,
with the cumulative incidence of recurrences increasing to 56% at three years,
60% at five years,
and 68% at ten years.
Figure 2.
Although a trend is seen,
sub-staging (IIIa,
IIIb,
IIIc) was not statistically significantly associated with OS and PFS in our study.
Sub-staging was only correlated with PFS through its correlation with ECE; Stage...
Conclusion
Most recurrences (49%) occurred within the first two years after resection This suggests the most intensive follow-up should be undertaken in the first two years.
ECE was the only measured variable significantly associated with PFS and OS.
The authors postulate ECE should be included as a potential prognosticator.
Further studies will be helpful in determining if using ECE to determine follow-up schedules,
together with stage III sub-staging,
can increase early detection of first relapse.
References
Australian Institute of Health and Welfare.Cancer in Australia: An overview,
2014.
AIHW cat.no.
CAN 88.Canberra,
Australia; 2014 Available from: www.aihw.gov.au.
Balch C.
Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system.
J Clin Oncol.
2001;19(16):3622-34.
Joseph R.
Baseline tumor size as an independent prognostic factor for overall survival in patients with metastatic melanoma treated with the anti-PD-1 monoclonal antibody MK-3475.
J Clin Oncol.
2014;32(5s).
Metabolic tumor burden for prediction of overall survival following combined BRAF/MEK inhibition...