TY - JOUR
T1 - Predicting Recurrence-Free and Overall Survival for Patients With Stage II Melanoma
T2 - The MIA Calculator
AU - Varey, Alexander H.R.
AU - Li, Isabel
AU - El Sharouni, Mary Ann
AU - Simon, Julie
AU - Dedeilia, Aikaterini
AU - Ch’ng, Sydney
AU - Saw, Robyn P.M.
AU - Spillane, Andrew J.
AU - Shannon, Kerwin F.
AU - Pennington, Thomas E.
AU - Rtshiladze, Michael
AU - Stretch, Jonathan R.
AU - Nieweg, Omgo E.
AU - van Akkooi, Alexander
AU - Sullivan, Ryan J.
AU - Boland, Genevieve M.
AU - Gershenwald, Jeffrey E.
AU - van Diest, Paul J.
AU - Scolyer, Richard A.
AU - Long, Georgina V.
AU - Thompson, John F.
AU - Lo, Serigne N.
N1 - Publisher Copyright:
© 2024 by American Society of Clinical Oncology.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - 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 5 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).
AB - 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 5 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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U2 - 10.1200/JCO.23.01020
DO - 10.1200/JCO.23.01020
M3 - Article
C2 - 38315961
AN - SCOPUS:85188576115
SN - 0732-183X
VL - 42
SP - 1169
EP - 1180
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 10
ER -