Czerniak – Rokowania, prognozy i postęp choroby

Czerniak
Rokowania, prognozy i postęp choroby

Rokowanie w czerniaku jest ściśle związane z wieloma czynnikami klinicznymi i histopatologicznymi, z których kluczową rolę odgrywa grubość guza pierwotnego mierzona skalą Breslowa. Czerniaki o grubości ≤1,00 mm cechują się bardzo dobrym rokowaniem, z 10-letnią przeżywalnością przekraczającą 95%, natomiast guzy powyżej 4,00 mm wiążą się z 5-letnią przeżywalnością na poziomie 26,66%. Obecność owrzodzenia, wysoki wskaźnik mitotyczny oraz zajęcie regionalnych węzłów chłonnych pogarszają prognozę, przy czym 5-letnia przeżywalność pacjentów z przerzutami w węzłach wynosi około 77%. Lokalizacja guza na kończynach sprzyja lepszemu rokowaniu w porównaniu do zmian na tułowiu, głowie czy szyi. W stadium IV, charakteryzującym się przerzutami odległymi, mediana przeżycia wynosi mniej niż rok, a czynniki takie jak liczba miejsc przerzutów, lokalizacja w narządach wewnętrznych oraz podwyższony poziom LDH we krwi są związane z gorszym rokowaniem.

Wprowadzenie do rokowania w czerniaku

Rokowanie (prognoza) w czerniaku (ang. melanoma) to przewidywanie prawdopodobnego przebiegu choroby oraz szans pacjenta na przeżycie. Jest to kalkulowane przypuszczenie, które może ulec zmianie w trakcie leczenia i przebiegu choroby. Czerniak jest najgroźniejszym nowotworem skóry, który charakteryzuje się możliwością szybkiego rozprzestrzeniania się, szczególnie w zaawansowanych stadiach.¹²

Rokowanie w czerniaku zależy od wielu czynników, z których najważniejsze to stopień zaawansowania choroby w momencie rozpoznania. Dobre rokowanie ma czerniak wykryty we wczesnym stadium – wówczas przeżywalność 5-letnia wynosi blisko 100%. Natomiast rokowanie znacząco pogarsza się, gdy diagnoza zostaje postawiona w późniejszych stadiach choroby.³⁴

Należy pamiętać, że statystyki przeżycia są bardzo ogólnymi szacunkami i muszą być interpretowane z dużą ostrożnością. Ponieważ dane te opierają się na doświadczeniach grup pacjentów, nie mogą być użyte do dokładnego przewidywania szans przeżycia konkretnej osoby. Tylko lekarz, który jest zaznajomiony z indywidualnym przypadkiem pacjenta, może połączyć wszystkie informacje ze statystykami przeżycia, aby przedstawić prognozę.⁵⁶

Kluczowe czynniki wpływające na rokowanie

Grubość guza pierwotnego

Grubość pierwotnego guza (mierzona według skali Breslowa) jest najważniejszym histologicznym parametrem prognostycznym w czerniaku. Odnosi się ona do liczby warstw skóry, w które guz wrósł. Jest to istotny czynnik rokowniczy, ponieważ pomaga przewidzieć ryzyko rozprzestrzenienia się nowotworu.⁷

Grubsze guzy mają wyższe ryzyko rozprzestrzeniania się do innych części ciała i nawrotu po leczeniu. Im grubszy guz, tym gorsze rokowanie. Czerniaki o grubości powyżej 4,00 mm mają niższą przeżywalność (5-letnia przeżywalność: 26,66%).⁸⁹

Należy zauważyć, że zmiany o grubości ≤1,00 mm zazwyczaj mają bardzo dobre rokowanie – ponad 95% pacjentów z tak cienkimi czerniakami żyje po 10 latach od diagnozy.¹⁰

Owrzodzenie guza

Owrzodzony guz pierwotny ma mniej korzystne rokowanie niż guz bez owrzodzenia. Owrzodzenie zwiększa ryzyko rozprzestrzenienia się nowotworu do innych części ciała i nawrotu po leczeniu.¹¹¹²

Wskaźnik mitotyczny

Zwiększony wskaźnik mitotyczny (liczba podziałów komórkowych) jest związany z gorszym rokowaniem.¹³

Zajęcie węzłów chłonnych

Jeśli nowotwór rozprzestrzenił się do pobliskich węzłów chłonnych, rokowanie jest gorsze. Im więcej węzłów chłonnych zawiera komórki nowotworowe, tym gorsze rokowanie. Obecność przerzutów w regionalnych węzłach chłonnych przekłada się na ogólną 5-letnią przeżywalność na poziomie 77% i 10-letnią przeżywalność na poziomie 69%.¹⁴¹⁵

Najważniejszym czynnikiem prognostycznym dla czerniaka w III stopniu zaawansowania jest liczba zajętych węzłów chłonnych. Pacjenci z mikroprzerzutami w węzłach chłonnych mają lepszą przeżywalność w porównaniu z pacjentami z klinicznie wyczuwalnymi węzłami.¹⁶

Lokalizacja anatomiczna

Czerniak zlokalizowany na kończynach (ramionach lub nogach) ma lepsze rokowanie niż czerniak zlokalizowany na centralnej części ciała (tułowiu), głowie lub szyi.¹⁷¹⁸

Przeżycie może być krótsze, jeśli czerniak występuje na stopie, dłoni lub pod paznokciem.¹⁹

Płeć i wiek

Kobiety mają tendencję do lepszego rokowania niż mężczyźni po zdiagnozowaniu czerniaka. Pacjenci w wieku poniżej 35 lat mają większe ryzyko rozprzestrzenienia się czerniaka do pobliskich węzłów chłonnych. Jednak ogólnie rzecz biorąc, osoby starsze mają gorsze rokowanie.²⁰²¹²²

Typ histologiczny

Czerniak guzkowy (nodular melanoma) ma gorsze rokowanie, ponieważ rośnie w głąb warstw skóry (pionowy wzorzec wzrostu) i zwykle jest gruby w momencie diagnozy. Czerniak powierzchownie rozprzestrzeniający się (superficial spreading) lub czerniak typu lentigo maligna mają najlepsze rokowanie wśród podtypów histologicznych.²³²⁴

Przerzuty odległe

Czerniak ma złe rokowanie, gdy rozprzestrzenia się do innych części ciała (tzw. przerzuty odległe), takich jak płuca, wątroba czy mózg. W IV stadium choroby, gdy występują przerzuty odległe, nowotwór jest generalnie uznawany za nieuleczalny, a mediana przeżycia wynosi mniej niż rok, choć niektórzy pacjenci żyją przez kilka lat.²⁵²⁶²⁷

Dla IV stopnia zaawansowania, zmienne prognostyczne wskazujące na gorsze rokowanie obejmują zwiększoną liczbę miejsc przerzutów, lokalizację przerzutów w narządach wewnętrznych (płuca, wątroba, mózg, kości), brak resekcyjnych przerzutów, płeć męską i krótszy czas remisji.²⁸

Parametry biochemiczne

W przypadku przerzutowego czerniaka, wysoki poziom dehydrogenazy mleczanowej (LDH) we krwi ma gorsze rokowanie niż gdy poziom LDH jest normalny.²⁹³⁰

Statystyki przeżywalności wg stadium zaawansowania

Przeżywalność różni się w zależności od stadium czerniaka. Generalnie, im wcześniej czerniak zostanie zdiagnozowany i leczony, tym lepsze rokowanie.³¹

Stadium zaawansowania	Przeżywalność 5-letnia	Przeżywalność 10-letnia
Stadium I	około 97%	około 95%
Stadium II	około 85%	około 86%
Stadium IIA	81%	67%
Stadium IIB	około 70%	około 57%
Stadium IIC	około 53%	40%
Stadium IIIA	około 78%	68%
Stadium IIIB	około 59%	około 43%
Stadium IIIC	około 40%	około 24%
Stadium IV	15-20%	10-15%

³²³³

Warto zauważyć, że w Kanadzie ogólna 5-letnia przeżywalność netto dla czerniaka skóry wynosi 89%. Oznacza to, że średnio około 89% osób zdiagnozowanych z czerniakiem będzie żyło przez co najmniej 5 lat.³⁴

W ostatnich latach, dzięki nowym terapiom, niektórzy pacjenci żyją z czerniakiem w IV stadium przez długi czas. W Wielkiej Brytanii przeżywalność dla wszystkich stadiów czerniaka wynosi: prawie 100% po 1 roku, prawie 95% po 5 latach i ponad 85% po 10 latach.³⁵³⁶

Nowoczesne modele prognostyczne i biomarkery

Całkowita objętość metaboliczna guza

Całkowita objętość metaboliczna guza (TMTV – Total Metabolic Tumour Volume) określona na podstawie badania PET/CT z użyciem fluorodeoksyglukozy jest obiecującym biomarkerem predykcyjnym dla pacjentów z czerniakiem przerzutowym. W analizach wykazano, że TMTV powyżej 90 ml ma najwyższy współczynnik ryzyka dla przeżycia całkowitego, a następnie obciążenie nowotworowe w wątrobie większe niż 30 ml.³⁷³⁸

W jednym z badań opracowano model predykcyjny łączący TMTV, poziomy dehydrogenazy mleczanowej (LDH) i obecność przerzutów do mózgu, który osiągnął obszar pod krzywą 0,78 dla jednego roku i 0,70 dla dwóch lat przeżycia. Automatycznie wyodrębniona wartość TMTV na podstawie całego ciała w badaniu PET/CT może pomóc w budowaniu modeli predykcyjnych wspierających decyzje terapeutyczne u pacjentów leczonych inhibitorami punktów kontrolnych układu immunologicznego.³⁹

Sygnatury genetyczne i molekularne

Rozwinięto kilka sygnatur genetycznych i molekularnych mających na celu poprawę przewidywania rokowania w czerniaku:

Sygnatura 31 genów (DecisionDx) – jest to najbardziej zwalidowany panel ekspresji genów w czerniaku, który okazał się mieć silną niezależną wartość prognostyczną.⁴⁰
Sygnatura par genów związanych z układem immunologicznym (IRGPs) – składająca się z 33 par genów, która jest znacząco związana z przeżyciem pacjentów i pozostaje niezależnym predyktorem przeżycia całkowitego.⁴¹⁴²
Immunogenna śmierć komórkowa (ICDscore) – wykazała silną zdolność przewidywania rokowania i wyższą skuteczność niż parametry kliniczne.⁴³⁴⁴

Modele prognozowania dla przerzutów do mózgu

Pacjenci z czerniakiem często rozwijają przerzuty do mózgu, co stanowi ok. 40-60% przypadków w przebiegu choroby. Opracowano specjalne skale prognostyczne dla tych pacjentów, jednak należy zachować ostrożność, ponieważ nie wszystkie zostały zweryfikowane u pacjentów leczonych zarówno radioterapią stereotaktyczną (SRT), jak i terapią celowaną/immunoterapią (TT/IT).⁴⁵

W jednym z badań zaproponowano skalę VTS, która okazała się być bardziej przydatna niż powszechnie stosowana skala molGPA dla pacjentów z przerzutami do mózgu otrzymujących równocześnie IT/TT i SRT. Mediana przeżycia całkowitego w trzech grupach skali VTS wynosiła odpowiednio 5,1, 18,9 i 34,5 miesiąca.⁴⁶⁴⁷

Kalkulatory ryzyka

Zespół Melanoma Institute Australia opracował serię kalkulatorów ryzyka online, które mają na celu pomóc klinicystom w zapobieganiu, wczesnym wykrywaniu i optymalnym leczeniu czerniaka. Kalkulatory te szacują:

Osobiste ryzyko zachorowania na czerniaka
Prawdopodobieństwo rozprzestrzenienia się czerniaka do węzłów chłonnych
Ryzyko rozwinięcia kolejnego pierwotnego czerniaka w ciągu 10 lat po ostatnim
Ryzyko nawrotu miejscowego, regionalnego lub odległego w ciągu 10 lat po pierwotnym czerniaku
Ryzyko nawrotu i przeżycie całkowite dla pacjentów z czerniakiem w II stadium⁴⁸

Wpływ nowych terapii na długoterminowe przeżycie

Leczenie czerniaka przeszło rewolucję w ciągu ostatniej dekady. Długoterminowe wyniki z zastosowaniem leków immuno-onkologicznych (I-O) i terapii ukierunkowanych dostarczają dowodów na trwałe przeżycie znacznej liczby pacjentów.⁴⁹

Obecne wyniki wskazują, że w zależności od leczenia, ponad 50% pacjentów z czerniakiem może uzyskać trwałą korzyść pod względem przeżycia. Najlepsze wyniki przeżycia obserwuje się zazwyczaj u pacjentów z korzystnymi czynnikami prognostycznymi, szczególnie z normalnym poziomem dehydrogenazy mleczanowej i/lub małą objętością choroby.⁵⁰⁵¹

Niektórzy pacjenci mogą być uznani za funkcjonalnie wyleczonych, jeśli odpowiedzieli na leczenie i pozostali bez leczenia przez co najmniej 2 lata bez progresji choroby. Dane wskazują, że kilka podejść terapeutycznych oferuje potencjał długoterminowego przeżycia. Połączona immunoterapia z inhibitorami CTLA-4 i PD-1 daje najwyższy plateau przeżycia całkowitego (do 52% pacjentów).⁵²⁵³

Znaczenie regresji w pierwotnym czerniaku

Regresja jest parametrem histopatologicznym, który jest zazwyczaj raportowany przy diagnozie inwazyjnego pierwotnego czerniaka skóry, choć obecnie nie jest wymagany do określenia stadium. Badania analizujące znaczenie prognostyczne regresji dla wyniku pacjenta przyniosły kontrowersyjne wyniki, prawdopodobnie dlatego, że definicja i ocena regresji nie były spójne, a interpretacja patologów jest subiektywna.⁵⁴

Regresja może być ważnym wskaźnikiem prognostycznym, ponieważ udokumentowano kilka przypadków czerniaka, który początkowo przedstawiał się jako przerzuty regionalne (np. skórne lub węzłowe) w kontekście całkowitej regresji pierwotnego czerniaka lub nieznanego guza pierwotnego, co sugeruje związek między regresją a przerzutami.⁵⁵

Niektóre badania wykazały, że obecność regresji w czerniaku była związana ze złym rokowaniem, podczas gdy inne sugerowały, że regresja wskazuje na korzystny wynik. W niedawnym raporcie dotyczącym 321 przypadków cienkiego czerniaka (grubość Breslowa ≤1,00 mm), Yun i wsp. zasugerowali, że jednym z czynników przyczyniających się do złego rokowania związanego z regresją była zwiększona gęstość naczyń limfatycznych skóry i wynikające z tego zwiększone ryzyko inwazji naczyń limfatycznych.⁵⁶

Wnioski i przyszłe kierunki

Rokowanie w czerniaku zostało znacznie poprawione w ostatnich latach dzięki nowym terapiom i lepszemu zrozumieniu biologii tego nowotworu. Mimo to, nadal istnieją wyzwania w przewidywaniu indywidualnego rokowania dla pacjentów.

Jak pokazał przegląd systematyczny modeli predykcyjnych dla czerniaka, wszystkie modele są skuteczne w swojej wydajności predykcyjnej, jednak niska jakość dowodów budzi obawy co do tego, czy obecne zalecenia dotyczące obserwacji po leczeniu chirurgicznym są odpowiednie. Przyszłe modele powinny uwzględniać biomarkery dla poprawy dokładności.⁵⁷⁵⁸

Przyszłe badania powinny koncentrować się na walidacji istniejących modeli z wykorzystaniem wytycznych TRIPOD w celu poprawy jakości raportowania. Powinny one również wykorzystywać analizę krzywych decyzyjnych do analizy korzyści netto z zastosowania modelu predykcyjnego.⁵⁹

Warto podkreślić, że statystyki przeżywalności dla czerniaka dopiero zaczynają odzwierciedlać postępy w leczeniu, jakie dokonały się w ostatnich latach. Rzeczywiste dane przeżycia dla pacjentów leczonych najnowszymi terapiami mogą być lepsze niż wynika to z dostępnych obecnie statystyk.⁶⁰

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Materiały źródłowe

#1 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. […] The following are prognostic and predictive factors for melanoma skin cancer. […] The thickness of the primary tumour refers to how many layers of skin it has grown into. It is an important prognostic factor because it helps predict the risk that the cancer will spread. Thicker tumours have a higher risk of spreading to other parts of the body and coming back (recurring) after treatment. The thicker the tumour, the poorer the prognosis. […] An ulcerated primary tumour has a less favourable prognosis than one that isn’t ulcerated. Ulceration increases the risk that the cancer will spread to other parts of the body and come back after treatment.
#2 Predicting the clinical outcome of melanoma using an immune-related gene pairs signature | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240331
Melanoma is rare but dangerous skin cancer, and it can spread rather quickly in the advanced stages of the tumor. […] A robust gene risk model could provide an accurate prediction of clinical outcomes. […] The present study aimed to explore a robust signature of immune-related gene pairs (IRGPs) for estimating overall survival (OS) in malignant melanoma. […] A signature consisted of 33 IRGPs was established which was significantly associated with patients survival in the TCGA-SKCM dataset (P = 2.01016, Hazard Ratio (HR) = 4.220 (2.909 to 6.122)). […] The prognostic efficacy of the signature remained unaffected regardless of whether BRAF or NRAS was mutated. […] The results of the present study support the IRGPs signature as a promising marker for prognosis prediction in melanoma.
#3 Azthena logo with the word Azthena
https://www.news-medical.net/health/Melanoma-Prognosis.aspx
The prognosis for a patient with melanoma depends on a number of different characteristics of the tumor, including the type and stage of progression. […] If melanoma can be diagnosed early, the prognosis is very high with a survival rate close to 100%, but the prognosis is significantly worsened if the diagnosis is not made until the later stages of progression. […] If the melanoma has spread to the nearby lymph nodes, the number and extent of affected nodes are important indicators of the severity of the disease. […] Certain types of melanoma are associated with a better or poorer prognosis, which is usually related to the typical thickness of the type. […] The size of the metastases changes the prognosis, with micrometastases associated with a better prognosis than patients with macrometastases.
#4 Melanoma: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/melanoma-your-chances-recovery-prognosis
Prognosis is the word your health care team may use to describe your chances of recovering from cancer. Or it may mean your likely outcome from cancer and cancer treatment. A prognosis is a calculated guess. Its a question many people have when they learn they have cancer. […] A doctor who is most familiar with your health is in the best position to discuss your prognosis with you and explain what the statistics may mean in your case. At the same time, you should keep in mind that your prognosis can change. Cancer and cancer treatment outcomes are hard to predict. For instance, a favorable prognosis (which means youre likely going to do well) can change if the cancer spreads to key organs or doesnt respond to treatment. An unfavorable prognosis can change, too. This can happen if treatment shrinks and controls the cancer so it doesnt grow or spread.
#5 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Survival statistics for cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for melanoma skin cancer is 89%. This means that, on average, about 89% of people diagnosed with melanoma will live for at least 5 years. […] Survival varies with each stage of melanoma. Generally, the earlier melanoma is diagnosed and treated, the better the outcome. Most melanomas are found at an early stage and this type of cancer often responds well to cancer treatment. […] Melanoma-specific survival is an estimate of the percentage of people with melanoma who have not died from the disease in a certain period of time since diagnosis.
#6 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Talk to your doctor about your prognosis. A prognosis depends on many factors, including: your health history, the type of cancer, where the cancer started on the skin, the stage, including how thick the tumour is and if there is broken skin with an open wound (called ulceration), the treatments chosen, how the cancer responds to treatment. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#7 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. […] The following are prognostic and predictive factors for melanoma skin cancer. […] The thickness of the primary tumour refers to how many layers of skin it has grown into. It is an important prognostic factor because it helps predict the risk that the cancer will spread. Thicker tumours have a higher risk of spreading to other parts of the body and coming back (recurring) after treatment. The thicker the tumour, the poorer the prognosis. […] An ulcerated primary tumour has a less favourable prognosis than one that isn’t ulcerated. Ulceration increases the risk that the cancer will spread to other parts of the body and come back after treatment.
#8 Analysis of prognostic factors for melanoma patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC5467960/
Melanoma is the most dangerous form of skin cancer. Morbidity from melanoma is increasing every year. Previous studies have revealed that there are some demographic and clinical factors having effect on melanoma survival prognosis. […] Purpose of our study was to assess melanoma survival depending on prognostic factors, such as age, sex, stage, depth, histology and anatomical site. […] Melanomas diagnosed at stage IV or thicker than 4.00 mm had lower survival (five-year survival: 12.5% and 26.66%, respectively). A significant survival difference was observed among the different stages (p = 0.003) and different depths (p = 0.049) of melanoma. […] Lower melanoma-specific survival rates were observed among patients diagnosed at a late stage, older age, and when melanomas were thicker than 4.00 mm.
#9
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/cutaneous-malignant-melanoma/
Approximately 85% of patients with melanoma have localized disease (stages I and II) at presentation, about 15% have regional nodal disease, and only about 2% have distant metastases at the time of diagnosis. The prognosis for stage I and II melanoma can be affected by many factors. Clinical factors associated with a favorable prognosis include younger age, female sex, and extremity lesions. Increasing Breslow thickness is the most important negative prognostic indicator, with worse survival for every stratum of tumor thickness in the American Joint Committee on Cancer staging guidelines. Other histologic variables associated with a poor prognosis include ulceration, diminished lymphoid response, evidence of tumor regression, microscopic satellites, lymphovascular invasion, and nonspindle-cell type tumors.
#10 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. […] The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists interpretation. […] Breslow thickness is the most important histologic parameter predicting outcome in primary cutaneous melanomas. […] Lesions with thickness 1.00mm usually have a very good prognosis; more than 95% of patients with such thin melanomas are alive at 10 years after diagnosis. […] However, some patients with a thin lesion develop metastasis, and thus, it is controversial whether sentinel lymphadenectomy should be performed in addition to wide local excision for primary lesions 1.00mm.
#11 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. […] The following are prognostic and predictive factors for melanoma skin cancer. […] The thickness of the primary tumour refers to how many layers of skin it has grown into. It is an important prognostic factor because it helps predict the risk that the cancer will spread. Thicker tumours have a higher risk of spreading to other parts of the body and coming back (recurring) after treatment. The thicker the tumour, the poorer the prognosis. […] An ulcerated primary tumour has a less favourable prognosis than one that isn’t ulcerated. Ulceration increases the risk that the cancer will spread to other parts of the body and come back after treatment.
#12 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Talk to your doctor about your prognosis. A prognosis depends on many factors, including: your health history, the type of cancer, where the cancer started on the skin, the stage, including how thick the tumour is and if there is broken skin with an open wound (called ulceration), the treatments chosen, how the cancer responds to treatment. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#13 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] People younger than 35 years of age have a greater risk of melanoma spreading to nearby lymph nodes. But, overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#14 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] People younger than 35 years of age have a greater risk of melanoma spreading to nearby lymph nodes. But, overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#15
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/cutaneous-malignant-melanoma/
The presence of regional lymph node metastases imparts an overall 5-year melanoma-specific survival rate of 77% and a 10-year melanoma-specific survival of 69%. When adjusting for size of lymph node deposits and number of nodes involved, the melanoma-specific survival ranges from 57% to 82% at 5 years and 47% to 75% at 10 years. The most important prognostic factor for stage III melanoma is the number of positive lymph nodes. Patients with nodal micrometastases have an improved survival compared with patients with clinically palpable nodes. Patients with melanoma on an extremity and younger age at diagnosis have been shown to have a better prognosis. If there are distant metastases, median survival is about 6 to 9 months. […] For stage IV, the prognostic variables suggesting worse prognosis include increasing number of metastatic sites, visceral location of metastases (lung, liver, brain, bone), absence of resectable metastases, male sex, and shorter duration of remission. Patients with nonvisceral disease (eg, skin, subcutaneous tissue, lymph nodes) have a better median survival rate, ranging from 12 to 15 months, and are more likely to respond to chemotherapy.
#16
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/cutaneous-malignant-melanoma/
The presence of regional lymph node metastases imparts an overall 5-year melanoma-specific survival rate of 77% and a 10-year melanoma-specific survival of 69%. When adjusting for size of lymph node deposits and number of nodes involved, the melanoma-specific survival ranges from 57% to 82% at 5 years and 47% to 75% at 10 years. The most important prognostic factor for stage III melanoma is the number of positive lymph nodes. Patients with nodal micrometastases have an improved survival compared with patients with clinically palpable nodes. Patients with melanoma on an extremity and younger age at diagnosis have been shown to have a better prognosis. If there are distant metastases, median survival is about 6 to 9 months. […] For stage IV, the prognostic variables suggesting worse prognosis include increasing number of metastatic sites, visceral location of metastases (lung, liver, brain, bone), absence of resectable metastases, male sex, and shorter duration of remission. Patients with nonvisceral disease (eg, skin, subcutaneous tissue, lymph nodes) have a better median survival rate, ranging from 12 to 15 months, and are more likely to respond to chemotherapy.
#17 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] People younger than 35 years of age have a greater risk of melanoma spreading to nearby lymph nodes. But, overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#18 Analysis of prognostic factors for melanoma patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC5467960/
Female and younger patients had better melanoma-specific survival than men and older people, and these differences were statistically significant. […] Melanoma diagnosed at an early stage and of a small depth had higher survival rates. […] Back/breast skin melanoma had poorer prognosis than other anatomic sites. […] Nodular melanoma had the lowest melanoma-specific survival, while superficial spreading or lentigo maligna had the best prognosis among histological subtypes. […] However, differences in melanoma survival in different sex and age groups, localizations and histological types were not statistically significant.
#19 Melanoma: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/melanoma-your-chances-recovery-prognosis
Survival can be shorter if the melanoma occurs on a foot, palm, or nail bed. […] People with melanoma who have had an organ transplant or who have HIV infection are also at higher risk of dying from melanoma. People with HIV have a weakened immune system. […] Although African Americans are less likely to get melanoma than whites, their survival rates are lower when they do get it.
#20 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] People younger than 35 years of age have a greater risk of melanoma spreading to nearby lymph nodes. But, overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#21 Analysis of prognostic factors for melanoma patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC5467960/
Female and younger patients had better melanoma-specific survival than men and older people, and these differences were statistically significant. […] Melanoma diagnosed at an early stage and of a small depth had higher survival rates. […] Back/breast skin melanoma had poorer prognosis than other anatomic sites. […] Nodular melanoma had the lowest melanoma-specific survival, while superficial spreading or lentigo maligna had the best prognosis among histological subtypes. […] However, differences in melanoma survival in different sex and age groups, localizations and histological types were not statistically significant.
#22 Survival for melanoma skin cancer | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/melanoma/survival
More than 55 out of 100 people (more than 55%) survived for 6 and a half years or more. […] Around 45 out of 100 people (around 45%) survived for 6 and a half years or more. […] almost all people (almost 100%) will survive their melanoma for 1 year or more […] almost 95 out of every 100 people (almost 95%) will survive their melanoma for 5 years or more […] more than 85 in 100 people (more than 85%) will survive their melanoma for 10 years or more. […] Your outlook depends on the stage of the cancer when it was diagnosed. […] Age can also affect outlook and younger people have a better prognosis than older people.
#23 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] People younger than 35 years of age have a greater risk of melanoma spreading to nearby lymph nodes. But, overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#24 Analysis of prognostic factors for melanoma patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC5467960/
Female and younger patients had better melanoma-specific survival than men and older people, and these differences were statistically significant. […] Melanoma diagnosed at an early stage and of a small depth had higher survival rates. […] Back/breast skin melanoma had poorer prognosis than other anatomic sites. […] Nodular melanoma had the lowest melanoma-specific survival, while superficial spreading or lentigo maligna had the best prognosis among histological subtypes. […] However, differences in melanoma survival in different sex and age groups, localizations and histological types were not statistically significant.
#25 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] People younger than 35 years of age have a greater risk of melanoma spreading to nearby lymph nodes. But, overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#26 Azthena logo with the word Azthena
https://www.news-medical.net/health/Melanoma-Prognosis.aspx
It is evident that the 5-year survival rate is lower with more advanced disease, as dictated by the diagnostic staging. […] In stage IV of the disease when there are distant metastases, the cancer is generally considered to be incurable and the median survival is less than once a year, although some patients live for several years.
#27
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/cutaneous-malignant-melanoma/
The presence of regional lymph node metastases imparts an overall 5-year melanoma-specific survival rate of 77% and a 10-year melanoma-specific survival of 69%. When adjusting for size of lymph node deposits and number of nodes involved, the melanoma-specific survival ranges from 57% to 82% at 5 years and 47% to 75% at 10 years. The most important prognostic factor for stage III melanoma is the number of positive lymph nodes. Patients with nodal micrometastases have an improved survival compared with patients with clinically palpable nodes. Patients with melanoma on an extremity and younger age at diagnosis have been shown to have a better prognosis. If there are distant metastases, median survival is about 6 to 9 months. […] For stage IV, the prognostic variables suggesting worse prognosis include increasing number of metastatic sites, visceral location of metastases (lung, liver, brain, bone), absence of resectable metastases, male sex, and shorter duration of remission. Patients with nonvisceral disease (eg, skin, subcutaneous tissue, lymph nodes) have a better median survival rate, ranging from 12 to 15 months, and are more likely to respond to chemotherapy.
#28
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/cutaneous-malignant-melanoma/
The presence of regional lymph node metastases imparts an overall 5-year melanoma-specific survival rate of 77% and a 10-year melanoma-specific survival of 69%. When adjusting for size of lymph node deposits and number of nodes involved, the melanoma-specific survival ranges from 57% to 82% at 5 years and 47% to 75% at 10 years. The most important prognostic factor for stage III melanoma is the number of positive lymph nodes. Patients with nodal micrometastases have an improved survival compared with patients with clinically palpable nodes. Patients with melanoma on an extremity and younger age at diagnosis have been shown to have a better prognosis. If there are distant metastases, median survival is about 6 to 9 months. […] For stage IV, the prognostic variables suggesting worse prognosis include increasing number of metastatic sites, visceral location of metastases (lung, liver, brain, bone), absence of resectable metastases, male sex, and shorter duration of remission. Patients with nonvisceral disease (eg, skin, subcutaneous tissue, lymph nodes) have a better median survival rate, ranging from 12 to 15 months, and are more likely to respond to chemotherapy.
#29 Prognosis and survival for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival
An increased mitotic rate is linked with a poor prognosis. […] If cancer has spread to nearby lymph nodes, the prognosis is poorer. The more lymph nodes that contain cancer, the poorer the prognosis. […] Having melanoma on the arms or legs (extremities) has a better prognosis than having melanoma on the central part of the body (trunk), head or neck. […] Women tend to have a better prognosis than men when diagnosed with melanoma. […] People younger than 35 years of age have a greater risk of melanoma spreading to nearby lymph nodes. But, overall, people who are older have a poorer prognosis. […] Nodular melanoma has a poor prognosis because it grows down into the layers of the skin (vertical growth pattern) and tends to be thick when diagnosed. […] Melanoma has a poor prognosis when it spreads to other parts of the body (called distant metastases), such as the lung, the liver or the brain. […] For metastatic melanoma, a high lactate dehydrogenase (LDH) level in the blood has a poorer prognosis than when the LDH level is normal.
#30 Evolving impact of long-term survival results on metastatic melanoma treatment | Journal for ImmunoTherapy of Cancer
https://jitc.bmj.com/content/8/2/e000948
Across studies, the best survival outcomes have generally been observed in patients with favorable prognostic factors, particularly a normal or low LDH level and/or a low volume of disease. […] When long-term data with immune checkpoint inhibitors became available in a pooled analysis of ipilimumab trials in which some patients were followed for more than 10 years, attention was drawn to the shape of the OS curves, specifically the plateau or flattening of the tail of the curve. […] This leads to the question of whether the patients represented in the tails of these curves can be considered to be functionally cured. […] We propose that patients diagnosed with advanced melanoma may be considered functionally cured if they have responded to treatment and have been off treatment for at least 2 years without disease progression.
#31 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Survival statistics for cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for melanoma skin cancer is 89%. This means that, on average, about 89% of people diagnosed with melanoma will live for at least 5 years. […] Survival varies with each stage of melanoma. Generally, the earlier melanoma is diagnosed and treated, the better the outcome. Most melanomas are found at an early stage and this type of cancer often responds well to cancer treatment. […] Melanoma-specific survival is an estimate of the percentage of people with melanoma who have not died from the disease in a certain period of time since diagnosis.
#32 Melanoma: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/melanoma-your-chances-recovery-prognosis
The 5-year survival rate is around 92%. The 10-year survival rate is around 86%. […] The 5-year survival rate is 81%. The 10-year survival rate is around 67%. […] The 5-year survival rate is around 70%. The 10-year survival rate is around 57%. […] The 5-year survival rate is around 53%. The 10-year survival rate is 40%. […] The 5-year survival rate is around 78%. The 10-year survival rate is 68%. […] The 5-year survival rate is around 59%. The 10-year survival rate is around 43%. […] The 5-year survival rate is around 40%. The 10-year survival rate is around 24%. […] The 5-year survival rate is around 15% to 20%. The 10-year survival rate is 10% to 15%. This rate is higher if the cancer has spread only to the skin or distant lymph nodes and not to vital organs. […] Factors other than stage also affect survival. For example: In general, survival declines with age.
#33 Survival for melanoma skin cancer | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/melanoma/survival
Survival depends on many factors. No one can tell you exactly how long you will live. […] Your doctor can give you more information about your own outlook (prognosis). […] Almost everyone (around 100%) with stage 1 melanoma skin cancer will survive their cancer for 5 years or more after they are diagnosed. […] Around 85 in 100 people (around 85%) with stage 2 melanoma skin cancer will survive their cancer for 5 years or more after diagnosis. […] Almost 75 in 100 people (almost 75%) with stage 3 melanoma skin cancer will survive their cancer for 5 years or more after they are diagnosed. […] In recent years, researchers have developed new treatments for stage 4 melanoma. Some immunotherapy treatments have had very good results so far. […] With new treatments, some people are living with stage 4 melanoma for a long time.
#34 Survival statistics for melanoma skin cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/melanoma-skin/prognosis-and-survival/survival-statistics
Survival statistics for cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for melanoma skin cancer is 89%. This means that, on average, about 89% of people diagnosed with melanoma will live for at least 5 years. […] Survival varies with each stage of melanoma. Generally, the earlier melanoma is diagnosed and treated, the better the outcome. Most melanomas are found at an early stage and this type of cancer often responds well to cancer treatment. […] Melanoma-specific survival is an estimate of the percentage of people with melanoma who have not died from the disease in a certain period of time since diagnosis.
#35 Survival for melanoma skin cancer | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/melanoma/survival
Survival depends on many factors. No one can tell you exactly how long you will live. […] Your doctor can give you more information about your own outlook (prognosis). […] Almost everyone (around 100%) with stage 1 melanoma skin cancer will survive their cancer for 5 years or more after they are diagnosed. […] Around 85 in 100 people (around 85%) with stage 2 melanoma skin cancer will survive their cancer for 5 years or more after diagnosis. […] Almost 75 in 100 people (almost 75%) with stage 3 melanoma skin cancer will survive their cancer for 5 years or more after they are diagnosed. […] In recent years, researchers have developed new treatments for stage 4 melanoma. Some immunotherapy treatments have had very good results so far. […] With new treatments, some people are living with stage 4 melanoma for a long time.
#36 Survival for melanoma skin cancer | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/melanoma/survival
More than 55 out of 100 people (more than 55%) survived for 6 and a half years or more. […] Around 45 out of 100 people (around 45%) survived for 6 and a half years or more. […] almost all people (almost 100%) will survive their melanoma for 1 year or more […] almost 95 out of every 100 people (almost 95%) will survive their melanoma for 5 years or more […] more than 85 in 100 people (more than 85%) will survive their melanoma for 10 years or more. […] Your outlook depends on the stage of the cancer when it was diagnosed. […] Age can also affect outlook and younger people have a better prognosis than older people.
#37 Development and Validation of a Predictive Model for Metastatic Melanoma Patients Treated with Pembrolizumab Based on Automated Analysis of Whole-Body [18F]FDG PET/CT Imaging and Clinical Features
https://www.mdpi.com/2072-6694/15/16/4083
The contribution of this study is threefold. First, in addition to known imaging features, like TMTV, more specific volumetric features were extracted and assessed for their predictive power. The proposed method starts from the whole-body PET/CT image in Digital Imaging and Communications in Medicine (DICOM) format, derives all needed parameters from the metadata and preprocesses the imaging data, completes a lesion segmentation, combines extracted features with clinical parameters that are given as input and performs a prognosis prediction for patients with advanced melanoma that will be treated with pembrolizumab. […] The thresholds that led to the lowest p-value in a logrank test comparing KaplanâMeier survival curves are summarised. For OS, the hazard ratios indicated a potential predictive value in TMTV, TLG and the volume of liver, spleen and GI tract metastases at baseline. For PFS, this list was reduced to TMTV and the volume of liver metastases. Irrespective of how the lesions were segmented, a TMTV of more than 90 mL has the highest hazard ratio for OS, followed by a tumour load in the liver greater than 30 mL and a total lesion glycolysis surpassing 400 SUVÂ·mL.
#38 Development and Validation of a Predictive Model for Metastatic Melanoma Patients Treated with Pembrolizumab Based on Automated Analysis of Whole-Body [18F]FDG PET/CT Imaging and Clinical Features
https://www.mdpi.com/2072-6694/15/16/4083
The proposed automated pipeline achieved an AUC of 0.78 for prediction at one year and 0.70 at two years. For the former, the model estimated a baseline survival probability of 0.82 with multivariate hazard ratios of 1.004 for TMTV, 2.59 for LDH and 2.52 for brain metastases. The addition of the lesion volume in the spleen or GI tract or of the CRP category did not offer any performance improvement. […] This study focused on the development and validation of prognostic prediction models for patients with advanced melanoma treated with pembrolizumab using a combination of automatically extracted features from the whole-body [18F]FDG PET/CT scan and available clinical parameters. The obtained performance for the model predicting one-year overall survival indicates it could be of benefit in clinical routine for supporting therapeutic decisions.
#39 Development and Validation of a Predictive Model for Metastatic Melanoma Patients Treated with Pembrolizumab Based on Automated Analysis of Whole-Body [18F]FDG PET/CT Imaging and Clinical Features
https://www.mdpi.com/2072-6694/15/16/4083
Development and Validation of a Predictive Model for Metastatic Melanoma Patients Treated with Pembrolizumab Based on Automated Analysis of Whole-Body [18F]FDG PET/CT Imaging and Clinical Features […] Blockade of the programmed cell death protein 1 (PD-1) receptor is an established standard-of-care treatment option that significantly improves survival of patients with advanced melanoma. Prediction of upfront resistance to therapy as well as durable responders based on biomarkers that correlate with survival is key in selecting an optimal personalised treatment plan. Previously we reported that total metabolic tumour volume (TMTV) determined by whole-body [18F]FDG PET/CT is a baseline predictive biomarker that deserves further investigation. In the development set of 69 patients, overall survival prediction based on TMTV, lactate dehydrogenase levels and presence of brain metastases achieved an area under the curve of 0.78 at one year, 0.70 at two years. Automatically extracted TMTV based on whole-body [18F]FDG PET/CT can aid in building predictive models that can support therapeutic decisions in patients treated with immune-checkpoint blockade.
#40 Molecular Pathology of Skin Melanoma: Epidemiology, Differential Diagnostics, Prognosis and Therapy Prediction
https://www.mdpi.com/1422-0067/23/10/5384
The prognostication of skin melanoma is still based on staging but can be completed with gene expression analysis (DecisionDx). […] The most widely used immunotherapies in patients with cutaneous melanoma are immune checkpoint inhibitors, monoclonal antibodies targeting PD-1 or CTLA-4. In the case of these agents, no clinically validated predictive markers exist in melanoma. […] The most extensively validated prognostic melanoma gene signature is a 31-gene expression panel constructed from meta-analyses of skin and uveal melanoma signatures, containing four inner control genes. This 31-gene panel was retrospectively and prospectively analyzed clinically and proved to have strong independent prognostic power.
#41 Predicting the clinical outcome of melanoma using an immune-related gene pairs signature | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240331
Melanoma is rare but dangerous skin cancer, and it can spread rather quickly in the advanced stages of the tumor. […] A robust gene risk model could provide an accurate prediction of clinical outcomes. […] The present study aimed to explore a robust signature of immune-related gene pairs (IRGPs) for estimating overall survival (OS) in malignant melanoma. […] A signature consisted of 33 IRGPs was established which was significantly associated with patients survival in the TCGA-SKCM dataset (P = 2.01016, Hazard Ratio (HR) = 4.220 (2.909 to 6.122)). […] The prognostic efficacy of the signature remained unaffected regardless of whether BRAF or NRAS was mutated. […] The results of the present study support the IRGPs signature as a promising marker for prognosis prediction in melanoma.
#42 Predicting the clinical outcome of melanoma using an immune-related gene pairs signature | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240331
The IRGPs signature remained an independent predictive value of OS in both the univariate and multivariate Cox analysis in the validation dataset (P0.01). […] We constructed a robust prognosis-related signature for melanoma using a novel immune gene pair approach and successfully validated its efficacy in other external datasets.
#43 Identification and validation of immunogenic cell death-related score in uveal melanoma to improve prediction of prognosis and response to immunotherapy | Aging
https://www.aging-us.com/article/204680/text
Immunogenic cell death (ICD) could activate innate and adaptive immune response. […] The ICDscore could predict the prognosis of UVM patients in both the training and four validating cohorts. […] Patients with high ICDscore exhibited a substantial increase in immune cell infiltration and expression of immune checkpoint inhibitor-related genes, leading to a higher response rate to immunotherapy. […] In conclusion, we developed a robust and powerful ICD-related signature for evaluating the prognosis and benefits of immunotherapy that could serve as a promising tool to guide decision-making and surveillance for UVM patients. […] The ICDscore exhibited a strong capability in predicting prognosis and showed superior performance than the above-mentioned clinical parameters. […] The ICDscore was also compared with 19 previously published mRNA risk models.
#44 Identification and validation of immunogenic cell death-related score in uveal melanoma to improve prediction of prognosis and response to immunotherapy | Aging
https://www.aging-us.com/article/204680/text
Univariate Cox regression showed that only the ICDscore and four other signatures exhibited prognostic significance across all studied cohorts, indicating most signatures had a weak association with prognosis or had not been thoroughly validated. […] The potential application of the ICDscore in immunotherapy was also investigated, since UVM patients with high-ICDscore were enriched in immune related processes and exhibited significantly higher level of CD8 T cells. […] 23.75% of patients in the TCGA-UVM were predicted to be responders to immunotherapy. […] In particular, we noticed that patients in the high-ICDscore subgroup were predicted to have a higher percentage of patients responding to immunotherapy. […] In conclusion, we a robust ICD-related signature for evaluating the prognosis and benefits of immunotherapy of UVM patients.
#45 Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-020-01558-8
About 40-60% of melanoma patients will develop brain metastases during the course of their disease, which contributes to a worse prognosis and quality of life. […] Recent developments in the fields of targeted- and immunotherapy (TT/IT), as well as the now widespread use of stereotactic radiosurgery (single fraction, SRS) and stereotactic radiotherapy (fractionated stereotactic radiotherapy, SRT) have significantly improved survival. […] In the rapidly changing setting of treatment opportunities for melanoma patients it remains unclear, which patients benefit most from local treatment and there is a need for a reliable prognostic score to tailor treatment. […] Several scores have been developed aiming to predict survival in patients with brain metastases. […] However, caution is required as these scores have not been established or validated in patients treated with combined SRT and TT/IT.
#46 Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-020-01558-8
The score is four-tired as its predecessor and reflects the success of the advances in treatment by markedly prolonged median OS as compared to the ds-GPA. […] However, radiation treatment consisted of a multitude of different treatment regimens including surgery + SRT/WBRT, WBRT +/ SRT, or SRT alone. […] In contrast to the number of brain metastases, OS was significantly associated with the cumulative brain metastases volume: patients with a cumulative brain metastases volume of 1.5cc had a median OS of 15.5 months, while the median OS for 1.5cc brain metastases volume was 6.1 months. […] On multivariate analysis, only cumulative brain metastases volume, timing of metastases and type of systemic treatment remained statistically significant. […] The VTS score was significantly associated with OS with a median OS in the three groups of 5.1, 18.9 and 34.5 months, respectively.
#47 Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-020-01558-8
Hence, in a cohort of patients treated homogenously with concurrent IT/TT and SRT, other factors than those informing the molGPA score may be of improved prognostic power. […] In conclusion, this study shows for the first time, that the molGPA score has to be used with caution for the rapidly growing cohort of melanoma patients treated with SRT concurrent with immuno- or targeted therapies for brain metastases.
#48 Risk Calculators – Melanoma Institute Australia
https://melanoma.org.au/for-clinicians/risk-calculators/
The MIA team has developed a series of online Risk Prediction Calculators to guide clinicians in prevention, early detection and optimum treatment of melanoma. […] Calculator generates a personal melanoma risk, which is an estimation of risk of developing a first primary invasive melanoma during the rest of the individuals life. […] Calculator generates probability of melanoma having spread to lymph nodes. Typically a sentinel node biopsy is recommended for patients with a risk greater than 10% and may be considered for those with a risk between 5% and 10%. […] Calculator generates an estimation of risk of developing another primary melanoma over the 10 years following the patients most recent melanoma. […] Calculates the risks that the patient will be diagnosed with a local, regional or distant recurrence within 10 years after the primary melanoma. […] For Stage II melanoma patients the risks of recurrence and overall survival are estimated, enabling them and their clinicians to make more informed treatment decisions.
#49 Evolving impact of long-term survival results on metastatic melanoma treatment | Journal for ImmunoTherapy of Cancer
https://jitc.bmj.com/content/8/2/e000948
Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. […] Current findings indicate that, depending on the treatment, over 50% of patients with melanoma may gain durable survival benefit. The best survival outcomes are generally observed in patients with favorable prognostic factors, particularly normal baseline lactate dehydrogenase and/or a low volume of disease. […] Quality-of-life and mixture-cure modeling data, as well as metrics such as treatment-free survival, are helping to define the value of this long-term survival. […] We propose that some patients might be considered functionally cured if they have responded to treatment and remained treatment-free for at least 2 years without disease progression.
#50 Evolving impact of long-term survival results on metastatic melanoma treatment | Journal for ImmunoTherapy of Cancer
https://jitc.bmj.com/content/8/2/e000948
Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. […] Current findings indicate that, depending on the treatment, over 50% of patients with melanoma may gain durable survival benefit. The best survival outcomes are generally observed in patients with favorable prognostic factors, particularly normal baseline lactate dehydrogenase and/or a low volume of disease. […] Quality-of-life and mixture-cure modeling data, as well as metrics such as treatment-free survival, are helping to define the value of this long-term survival. […] We propose that some patients might be considered functionally cured if they have responded to treatment and remained treatment-free for at least 2 years without disease progression.
#51 Evolving impact of long-term survival results on metastatic melanoma treatment | Journal for ImmunoTherapy of Cancer
https://jitc.bmj.com/content/8/2/e000948
Across studies, the best survival outcomes have generally been observed in patients with favorable prognostic factors, particularly a normal or low LDH level and/or a low volume of disease. […] When long-term data with immune checkpoint inhibitors became available in a pooled analysis of ipilimumab trials in which some patients were followed for more than 10 years, attention was drawn to the shape of the OS curves, specifically the plateau or flattening of the tail of the curve. […] This leads to the question of whether the patients represented in the tails of these curves can be considered to be functionally cured. […] We propose that patients diagnosed with advanced melanoma may be considered functionally cured if they have responded to treatment and have been off treatment for at least 2 years without disease progression.
#52 Evolving impact of long-term survival results on metastatic melanoma treatment | Journal for ImmunoTherapy of Cancer
https://jitc.bmj.com/content/8/2/e000948
Across studies, the best survival outcomes have generally been observed in patients with favorable prognostic factors, particularly a normal or low LDH level and/or a low volume of disease. […] When long-term data with immune checkpoint inhibitors became available in a pooled analysis of ipilimumab trials in which some patients were followed for more than 10 years, attention was drawn to the shape of the OS curves, specifically the plateau or flattening of the tail of the curve. […] This leads to the question of whether the patients represented in the tails of these curves can be considered to be functionally cured. […] We propose that patients diagnosed with advanced melanoma may be considered functionally cured if they have responded to treatment and have been off treatment for at least 2 years without disease progression.
#53 Evolving impact of long-term survival results on metastatic melanoma treatment | Journal for ImmunoTherapy of Cancer
https://jitc.bmj.com/content/8/2/e000948
The current data indicate that several treatment approaches offer the potential for long-term survival. Combined CTLA-4 and PD-1 inhibitor immunotherapy results in the highest OS plateau (up to 52% of patients), and in our opinion, may achieve long-term survival (functional cure) in the greatest number of patients.
#54 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. […] The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists interpretation. […] Breslow thickness is the most important histologic parameter predicting outcome in primary cutaneous melanomas. […] Lesions with thickness 1.00mm usually have a very good prognosis; more than 95% of patients with such thin melanomas are alive at 10 years after diagnosis. […] However, some patients with a thin lesion develop metastasis, and thus, it is controversial whether sentinel lymphadenectomy should be performed in addition to wide local excision for primary lesions 1.00mm.
#55 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
Regression may be an important prognostic indicator, since several cases of melanoma presenting initially as regional metastases (eg, cutaneous or lymph node) have been documented in the setting of complete regression of the primary melanoma or an unknown primary tumor, suggesting an association between regression and metastasis. […] Thus, the prognostic impact of regression in patients with melanoma remains controversial. […] The prognostic significance of regression in primary melanoma has been controversial for many years. […] Several studies have failed to show a correlation between regression and patient outcome. […] In contrast, other studies have indicated that the presence of regression in melanoma was associated with a poor prognosis. […] On the other hand, additional studies have suggested that regression indicates a favorable outcome.
#56 Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance | Laboratory Investigation
https://www.nature.com/articles/labinvest20178
In a recent report of 321 cases of thin melanoma (Breslow thickness 1.00mm), Yun et al suggested that one of the factors contributing to poor prognosis associated with regression was the increased dermal lymphatic vessel density and the resulting increased risk of lymphovascular invasion. […] In a multifactorial analysis of prognostic variables, Balch et al demonstrated that the presence of regression did not affect survival rates in 339 patients with melanoma. […] In a study of 844 melanomas subdivided into three groups based on Breslow thickness (0.76, 0.761.5, and 1.5mm), Kelly et al reported the overall incidence of late-stage regression to be 20.4% with no difference in 5-year survival rates by lesion thickness. […] In contrast, Slingluff et al reported, in a study of 681 thin melanomas (Breslow thickness 0.76mm), that severe regression in thin melanomas was associated with decreased disease-free interval.
#57 Predictive accuracy of risk prediction models for recurrence, metastasis and survival for early-stage cutaneous melanoma: a systematic review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10546114/
To identify prognostic models for melanoma survival, recurrence and metastasis among American Joint Committee on Cancer stage I and II patients postsurgery; and evaluate model performance, including overall survival (OS) prediction. […] All models are effective in their predictive performance, however the low quality of the evidence raises concern as to whether current follow-up recommendations following surgical treatment is adequate. Future models should incorporate biomarkers for improved accuracy. […] This review identified 14 studies describing 20 different models developed for the prediction of recurrence, new primary tumours or metastasis in patients with AJCC stage I or II cutaneous melanoma following excision. […] The results of this systematic review highlight the relative lack of appropriate evidence underpinning current melanoma prediction tools to support practice in AJCC stage I and II disease.
#58 Predictive accuracy of risk prediction models for recurrence, metastasis and survival for early-stage cutaneous melanoma: a systematic review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10546114/
The data, which are heterogeneous in terms of biology and progression, do not offer a wide enough scope of best practice to allow accurate prognostication of melanoma AJCC stages I or II patients as defined by the criteria within the third, sixth, seventh and eighth editions of AJCC staging, or recommendation for use in clinical practice. This raises concern as to whether current follow-up recommendations postsurgical treatment is adequate as the evidence supporting such recommendation is sparse. Future research should focus on validating existing models utilising TRIPOD guidelines to improve reporting quality. Future studies should also look to use decision curve analysis to analyse the net benefit of using the predictive model.
#59 Predictive accuracy of risk prediction models for recurrence, metastasis and survival for early-stage cutaneous melanoma: a systematic review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10546114/
The data, which are heterogeneous in terms of biology and progression, do not offer a wide enough scope of best practice to allow accurate prognostication of melanoma AJCC stages I or II patients as defined by the criteria within the third, sixth, seventh and eighth editions of AJCC staging, or recommendation for use in clinical practice. This raises concern as to whether current follow-up recommendations postsurgical treatment is adequate as the evidence supporting such recommendation is sparse. Future research should focus on validating existing models utilising TRIPOD guidelines to improve reporting quality. Future studies should also look to use decision curve analysis to analyse the net benefit of using the predictive model.
#60 Survival Rates for Melanoma Skin Cancer – MRA
https://www.curemelanoma.org/about-melanoma/melanoma-staging/melanoma-survival-rates
Melanoma survival rates provide the proportion of people with a particular stage of melanoma who are alive after a predetermined amount of time, normally 5 or 10 years, after diagnosis. […] Although these numbers can be helpful to you when making treatment and other decisions, they do not dictate how long you will live. […] These survival rates are only beginning to reflect these advancements.