Patterns of Recurrence and Survival in Stage III Melanoma Patients: Implications for Follow-Up Guidelines Público

Mimche, Sylvie (Fall 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/0r9674590?locale=pt-BR
Published

Abstract

BACKGROUND:

Standard cancer staging and prognosis estimates are determined at the time of the patient’s initial disease presentation. Melanoma stage III is associated with a high risk of recurrence and mortality.With the introduction of new and innovative therapies for the treatment of patients with melanoma and the recent revision of the seven editions of the AJCC staging systems; The understanding of the pattern of recurrence and the survival outcomes of these high-risk patients is important to improve early detection and management of the disease. We propose to evaluate the patterns of recurrence and the survival prognosis of patients with melanoma stage III at diagnosis.

METHODS: A retrospective study of patients followed and treated at the Huntsman Cancer Institute of Utah between 2000 and 2015 was undertaken. We assessed the site and time of the first recurrence (TTR), the recurrence-free survival (RFS), the melanoma specific survival (MSS) and overall survival (OS) using Kaplan Meier survival probabilities and Cox-proportional hazard analysis.

RESULTS: A total of 554 patients with melanoma stage III at diagnosis were included in the analysis. Of these, 34% were stage IIIA, 22% stage IIIB, 42% stage IIIC and 4% stage IIID. The median age at diagnosis was 55 years and the median follow- up time was 51 months. One third of this cohort relapsed with a median time to recurrence of 14 months. The main site of recurrence was nodal (34%), local or in-transit (20%), lung (20%) and brain (10%). The majority of patients who relapsed within one year after curative surgery were from stage IIIA (31%), IIIB (42%) IIIC (41%), and IIID (67%). The estimated 5-years RFS rates for stage IIIA, IIIB, IIIC and IIID were 83%, 73%, 56%, and 47%; the MSS rate were 91%, 83%, 71% and 45.5% and the OS rate were 88%, 79%, 60% and 29% respectively.

The adjusted multivariable Cox regression models showed that stage IIIC (HR= 2.74, 95%CL 1.3- 5.4) and IIID (HR=3.86, 95%CL 1.4-10.5) were associated with an increase in the hazard of relapse compared to stage IIIA. Similarly, stage IIIC (HR= 3.5, 95%CL 1.9- 6.7) and IIID (HR= 9.6, 95%CL 4.0- 23.1) were associated with an increase in the hazards of death compared to stage IIIA.

CONCLUSIONS: Our data suggest that substage IIIC and IIID at diagnosis are associated with the higher risk of relapse and death. The fact that the majority of patients relapse before 2 years urges us to concentrate follow-up surveillance within this time period.

Table of Contents

CHAPTER I - Literature Review and Background………………………........1

CHAPTER II -Methodology ……………………………………………................6

CHAPTER III- Results ……………..............................................................10

CHAPTER IV- Discussion ………………………………………………................16

CHAPTER V- Limitations ………………………………………………................19

CHAPTER IV- Conclusions……………………………………………..................20

REFERENCES……….……………………………………………….........................22

TABLES

Table 1.......................................................................................................25

Table 2.......................................................................................................27

Table 3.......................................................................................................28

Table 4.......................................................................................................29

Table 5.......................................................................................................29

Table 6.......................................................................................................30

Table 7.......................................................................................................30

Table 8.......................................................................................................30

Table 9.......................................................................................................31

Table 10.....................................................................................................31

Table 11.....................................................................................................32

Table 12.....................................................................................................33

FIGURES

Figure1 & 2……………………………………………………………. ......................35

Figure3 & 4……………………………………………………………. ......................36

Figure5 & 6……………………………………………………………….....................37

Figure7 & 8……………………………………………………………….....................38

Figure9 & 10……………………………………………………………......................39

Figure11 & 12………………………………………………………….......................40

Figure13 & 14……………………………………………………………....................41

Figure15 & 16……………………………………………………………....................42

Figure17 &18…………………………………………………………….....................43

APPENDICES

SAS CODE……………………………………………………………….......................44

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