TY - JOUR
T1 - Cumulative incidence and predictors of CNS metastasis for patients with American Joint Committee on Cancer 8th Edition stage III melanoma
AU - Haydu, Lauren E.
AU - Lo, Serigne N.
AU - McQuade, Jennifer L.
AU - Amaria, Rodabe N.
AU - Wargo, Jennifer
AU - Ross, Merrick I.
AU - Cormier, Janice N.
AU - Lucci, Anthony
AU - Lee, Jeffrey E.
AU - Ferguson, Sherise D.
AU - Saw, Robyn P.M.
AU - Spillane, Andrew J.
AU - Shannon, Kerwin F.
AU - Stretch, Jonathan R.
AU - Hwu, Patrick
AU - Patel, Sapna P.
AU - Diab, Adi
AU - Wong, Michael K.K.
AU - Glitza Oliva, Isabella C.
AU - Tawbi, Hussein
AU - Carlino, Matteo S.
AU - Menzies, Alexander M.
AU - Long, Georgina V.
AU - Lazar, Alexander J.
AU - Tetzlaff, Michael T.
AU - Scolyer, Richard A.
AU - Gershenwald, Jeffrey E.
AU - Thompson, John F.
AU - Davies, Michael A.
N1 - Publisher Copyright:
© 2020 by American Society of Clinical Oncology.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - PURPOSE Improved understanding of the incidence, risk factors, and timing of CNS metastasis is needed to inform surveillance strategies for patients with melanoma. PATIENTS AND METHODS Clinical data were extracted from the databases of 2 major melanoma centers in the United States and Australia for 1,918 patients with American Joint Committee on Cancer (AJCC) 8th edition stage III melanoma, diagnosed from 1998-2014, who had (negative) baseline CNS imaging within 4 months of diagnosis. The cumulative incidence of CNS metastasis was calculated in the presence of the competing risk of death, from stage III presentation and at benchmark time points 1, 2, and 5 years postdiagnosis. RESULTS At a median follow-up of 70.2 months, distant recurrence occurred in 711 patients (37.1%). The first site of distant metastasis was CNS only for 3.9% of patients, CNS and extracranial (EC) for 1.8%, and EC only for 31.4%. Overall, 16.7% of patients were diagnosed with CNS metastasis during follow-up. The cumulative incidence of CNS metastasis was 3.6% (95% CI, 2.9% to 4.6%) at 1 year, 9.6% (95% CI, 8.3% to 11.0%) at 2 years, and 15.8% (95% CI, 14.1% to 17.6%) at 5 years. The risk of CNS metastasis was significantly influenced by patient sex, age, AJCC stage, primary tumor site, and primary tumor mitotic rate in multivariable and conditional analyses. High primary tumor mitotic rate was significantly associated with increased risk of CNS metastasis at diagnosis and all subsequent time points examined. CONCLUSION Similar rates of CNS metastasis were observed in 2 large, geographically distinct cohorts of patients with stage III melanoma. The results highlight the importance of primary tumor mitotic rate. Furthermore, they provide a framework for developing evidence-based surveillance strategies and evaluating the impact of contemporary adjuvant therapies on the risk of CNS metastasis development.
AB - PURPOSE Improved understanding of the incidence, risk factors, and timing of CNS metastasis is needed to inform surveillance strategies for patients with melanoma. PATIENTS AND METHODS Clinical data were extracted from the databases of 2 major melanoma centers in the United States and Australia for 1,918 patients with American Joint Committee on Cancer (AJCC) 8th edition stage III melanoma, diagnosed from 1998-2014, who had (negative) baseline CNS imaging within 4 months of diagnosis. The cumulative incidence of CNS metastasis was calculated in the presence of the competing risk of death, from stage III presentation and at benchmark time points 1, 2, and 5 years postdiagnosis. RESULTS At a median follow-up of 70.2 months, distant recurrence occurred in 711 patients (37.1%). The first site of distant metastasis was CNS only for 3.9% of patients, CNS and extracranial (EC) for 1.8%, and EC only for 31.4%. Overall, 16.7% of patients were diagnosed with CNS metastasis during follow-up. The cumulative incidence of CNS metastasis was 3.6% (95% CI, 2.9% to 4.6%) at 1 year, 9.6% (95% CI, 8.3% to 11.0%) at 2 years, and 15.8% (95% CI, 14.1% to 17.6%) at 5 years. The risk of CNS metastasis was significantly influenced by patient sex, age, AJCC stage, primary tumor site, and primary tumor mitotic rate in multivariable and conditional analyses. High primary tumor mitotic rate was significantly associated with increased risk of CNS metastasis at diagnosis and all subsequent time points examined. CONCLUSION Similar rates of CNS metastasis were observed in 2 large, geographically distinct cohorts of patients with stage III melanoma. The results highlight the importance of primary tumor mitotic rate. Furthermore, they provide a framework for developing evidence-based surveillance strategies and evaluating the impact of contemporary adjuvant therapies on the risk of CNS metastasis development.
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U2 - 10.1200/JCO.19.01508
DO - 10.1200/JCO.19.01508
M3 - Article
C2 - 31990608
AN - SCOPUS:85084128164
SN - 0732-183X
VL - 38
SP - 1429
EP - 1441
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 13
ER -