Prognostic factors analysis of 17,600 melanoma patients: Validation of the American Joint Committee on Cancer melanoma staging system

Charles M. Balch, S. J. Soong, J. E. Gershenwald, J. F. Thompson, D. S. Reintgen, N. Cascinelli, M. Urist, K. M. McMasters, M. I. Ross, J. M. Kirkwood, M. B. Atkins, J. A. Thompson, D. G. Coit, D. Byrd, R. Desmond, Y. Zhang, P. Y. Liu, G. H. Lyman, A. Morabito

Research output: Contribution to journalArticle

Abstract

Purpose: The American Joint Committee on Cancer (AJCC) recently proposed major revisions of the tumor-node-metastases (TNM) categories and stage groupings for cutaneous melanoma. Thirteen cancer centers and cancer cooperative groups contributed staging and survival data from a total of 30,450 melanoma patients from their databases in order to validate this staging proposal. Patients and Methods: There were 17,600 melanoma patients with complete clinical, pathologic, and follow-up information. Factors predicting melanoma-specific survival rates were analyzed using the Cox proportional hazards regression model. Follow-up survival data for 5 years or longer were available for 73% of the patients. Results: This analysis demonstrated that (1) in the T category, tumor thickness and ulceration were the most powerful predictors of survival, and the level of invasion had a significant impact only within the subgroup of thin (≤ 1 mm) melanomas; (2) in the N category, the following three independent factors were identified: the number of metastatic nodes, whether nodal metastases were clinically occult or clinically apparent, and the presence or absence of primary tumor ulceration; and (3) in the M category, nonvisceral metastases was associated with a better survival compared with visceral metastases. A marked diversity in the natural history of pathologic stage III melanoma was demonstrated by five-fold differences in 5-year survival rates for defined subgroups. This analysis also demonstrated that large and complex data sets could be used effectively to examine prognosis and survival outcome in melanoma patients. Conclusion: The results of this evidence-based methodology were incorporated into the AJCC melanoma staging as described in the companion publication.

Original languageEnglish (US)
Pages (from-to)3622-3634
Number of pages13
JournalJournal of Clinical Oncology
Volume19
Issue number16
StatePublished - Aug 15 2001
Externally publishedYes

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Neoplasm Staging
Statistical Factor Analysis
Melanoma
Survival
Neoplasm Metastasis
Neoplasms
Survival Rate
Natural History
Proportional Hazards Models
Publications
Databases
Skin

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Balch, C. M., Soong, S. J., Gershenwald, J. E., Thompson, J. F., Reintgen, D. S., Cascinelli, N., ... Morabito, A. (2001). Prognostic factors analysis of 17,600 melanoma patients: Validation of the American Joint Committee on Cancer melanoma staging system. Journal of Clinical Oncology, 19(16), 3622-3634.

Prognostic factors analysis of 17,600 melanoma patients : Validation of the American Joint Committee on Cancer melanoma staging system. / Balch, Charles M.; Soong, S. J.; Gershenwald, J. E.; Thompson, J. F.; Reintgen, D. S.; Cascinelli, N.; Urist, M.; McMasters, K. M.; Ross, M. I.; Kirkwood, J. M.; Atkins, M. B.; Thompson, J. A.; Coit, D. G.; Byrd, D.; Desmond, R.; Zhang, Y.; Liu, P. Y.; Lyman, G. H.; Morabito, A.

In: Journal of Clinical Oncology, Vol. 19, No. 16, 15.08.2001, p. 3622-3634.

Research output: Contribution to journalArticle

Balch, CM, Soong, SJ, Gershenwald, JE, Thompson, JF, Reintgen, DS, Cascinelli, N, Urist, M, McMasters, KM, Ross, MI, Kirkwood, JM, Atkins, MB, Thompson, JA, Coit, DG, Byrd, D, Desmond, R, Zhang, Y, Liu, PY, Lyman, GH & Morabito, A 2001, 'Prognostic factors analysis of 17,600 melanoma patients: Validation of the American Joint Committee on Cancer melanoma staging system', Journal of Clinical Oncology, vol. 19, no. 16, pp. 3622-3634.
Balch, Charles M. ; Soong, S. J. ; Gershenwald, J. E. ; Thompson, J. F. ; Reintgen, D. S. ; Cascinelli, N. ; Urist, M. ; McMasters, K. M. ; Ross, M. I. ; Kirkwood, J. M. ; Atkins, M. B. ; Thompson, J. A. ; Coit, D. G. ; Byrd, D. ; Desmond, R. ; Zhang, Y. ; Liu, P. Y. ; Lyman, G. H. ; Morabito, A. / Prognostic factors analysis of 17,600 melanoma patients : Validation of the American Joint Committee on Cancer melanoma staging system. In: Journal of Clinical Oncology. 2001 ; Vol. 19, No. 16. pp. 3622-3634.
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abstract = "Purpose: The American Joint Committee on Cancer (AJCC) recently proposed major revisions of the tumor-node-metastases (TNM) categories and stage groupings for cutaneous melanoma. Thirteen cancer centers and cancer cooperative groups contributed staging and survival data from a total of 30,450 melanoma patients from their databases in order to validate this staging proposal. Patients and Methods: There were 17,600 melanoma patients with complete clinical, pathologic, and follow-up information. Factors predicting melanoma-specific survival rates were analyzed using the Cox proportional hazards regression model. Follow-up survival data for 5 years or longer were available for 73{\%} of the patients. Results: This analysis demonstrated that (1) in the T category, tumor thickness and ulceration were the most powerful predictors of survival, and the level of invasion had a significant impact only within the subgroup of thin (≤ 1 mm) melanomas; (2) in the N category, the following three independent factors were identified: the number of metastatic nodes, whether nodal metastases were clinically occult or clinically apparent, and the presence or absence of primary tumor ulceration; and (3) in the M category, nonvisceral metastases was associated with a better survival compared with visceral metastases. A marked diversity in the natural history of pathologic stage III melanoma was demonstrated by five-fold differences in 5-year survival rates for defined subgroups. This analysis also demonstrated that large and complex data sets could be used effectively to examine prognosis and survival outcome in melanoma patients. Conclusion: The results of this evidence-based methodology were incorporated into the AJCC melanoma staging as described in the companion publication.",
author = "Balch, {Charles M.} and Soong, {S. J.} and Gershenwald, {J. E.} and Thompson, {J. F.} and Reintgen, {D. S.} and N. Cascinelli and M. Urist and McMasters, {K. M.} and Ross, {M. I.} and Kirkwood, {J. M.} and Atkins, {M. B.} and Thompson, {J. A.} and Coit, {D. G.} and D. Byrd and R. Desmond and Y. Zhang and Liu, {P. Y.} and Lyman, {G. H.} and A. Morabito",
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T1 - Prognostic factors analysis of 17,600 melanoma patients

T2 - Validation of the American Joint Committee on Cancer melanoma staging system

AU - Balch, Charles M.

AU - Soong, S. J.

AU - Gershenwald, J. E.

AU - Thompson, J. F.

AU - Reintgen, D. S.

AU - Cascinelli, N.

AU - Urist, M.

AU - McMasters, K. M.

AU - Ross, M. I.

AU - Kirkwood, J. M.

AU - Atkins, M. B.

AU - Thompson, J. A.

AU - Coit, D. G.

AU - Byrd, D.

AU - Desmond, R.

AU - Zhang, Y.

AU - Liu, P. Y.

AU - Lyman, G. H.

AU - Morabito, A.

PY - 2001/8/15

Y1 - 2001/8/15

N2 - Purpose: The American Joint Committee on Cancer (AJCC) recently proposed major revisions of the tumor-node-metastases (TNM) categories and stage groupings for cutaneous melanoma. Thirteen cancer centers and cancer cooperative groups contributed staging and survival data from a total of 30,450 melanoma patients from their databases in order to validate this staging proposal. Patients and Methods: There were 17,600 melanoma patients with complete clinical, pathologic, and follow-up information. Factors predicting melanoma-specific survival rates were analyzed using the Cox proportional hazards regression model. Follow-up survival data for 5 years or longer were available for 73% of the patients. Results: This analysis demonstrated that (1) in the T category, tumor thickness and ulceration were the most powerful predictors of survival, and the level of invasion had a significant impact only within the subgroup of thin (≤ 1 mm) melanomas; (2) in the N category, the following three independent factors were identified: the number of metastatic nodes, whether nodal metastases were clinically occult or clinically apparent, and the presence or absence of primary tumor ulceration; and (3) in the M category, nonvisceral metastases was associated with a better survival compared with visceral metastases. A marked diversity in the natural history of pathologic stage III melanoma was demonstrated by five-fold differences in 5-year survival rates for defined subgroups. This analysis also demonstrated that large and complex data sets could be used effectively to examine prognosis and survival outcome in melanoma patients. Conclusion: The results of this evidence-based methodology were incorporated into the AJCC melanoma staging as described in the companion publication.

AB - Purpose: The American Joint Committee on Cancer (AJCC) recently proposed major revisions of the tumor-node-metastases (TNM) categories and stage groupings for cutaneous melanoma. Thirteen cancer centers and cancer cooperative groups contributed staging and survival data from a total of 30,450 melanoma patients from their databases in order to validate this staging proposal. Patients and Methods: There were 17,600 melanoma patients with complete clinical, pathologic, and follow-up information. Factors predicting melanoma-specific survival rates were analyzed using the Cox proportional hazards regression model. Follow-up survival data for 5 years or longer were available for 73% of the patients. Results: This analysis demonstrated that (1) in the T category, tumor thickness and ulceration were the most powerful predictors of survival, and the level of invasion had a significant impact only within the subgroup of thin (≤ 1 mm) melanomas; (2) in the N category, the following three independent factors were identified: the number of metastatic nodes, whether nodal metastases were clinically occult or clinically apparent, and the presence or absence of primary tumor ulceration; and (3) in the M category, nonvisceral metastases was associated with a better survival compared with visceral metastases. A marked diversity in the natural history of pathologic stage III melanoma was demonstrated by five-fold differences in 5-year survival rates for defined subgroups. This analysis also demonstrated that large and complex data sets could be used effectively to examine prognosis and survival outcome in melanoma patients. Conclusion: The results of this evidence-based methodology were incorporated into the AJCC melanoma staging as described in the companion publication.

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