Development and validation of a nomogram to predict recurrence and melanoma-specific mortality in patients with negative sentinel lymph nodes.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
05
04
2018
revised:
04
06
2018
accepted:
08
08
2018
pubmed:
12
10
2018
medline:
30
7
2019
entrez:
12
10
2018
Statut:
ppublish
Résumé
Patients with melanoma and negative sentinel nodes (SNs) have varying outcomes, dependent on several prognostic factors. Considering all these factors in a prediction model might aid in identifying patients who could benefit from a personalized treatment strategy. The objective was to construct and validate a nomogram for recurrence and melanoma-specific mortality (MSM) in patients with melanoma and negative SNs. A total of 3220 patients with negative SNs were identified from a cohort of 4124 patients from four EORTC Melanoma Group centres who underwent sentinel lymph node biopsy. Prognostic factors for recurrence and MSM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c-index) and calibration in cross-validation across the four centres. A nomogram was developed for graphical presentation. There were 3180 eligible patients. The final prediction model for recurrence and the calibrated model for MSM included three independent prognostic factors: ulceration, anatomical location and Breslow thickness. The c-index was 0·74 for recurrence and 0·76 for the calibrated MSM model. Cross-validation across the four centres showed reasonable model performance. A nomogram was developed based on these models. One-third of the patients had a 5-year recurrence probability of 8·2 per cent or less, and one-third had a recurrence probability of 23·0 per cent or more. A nomogram for predicting recurrence and MSM in patients with melanoma and negative SNs was constructed and validated. It could provide personalized estimates useful for tailoring surveillance strategies (reduce or increase intensity), and selection of patients for adjuvant therapy or clinical trials.
Sections du résumé
BACKGROUND
Patients with melanoma and negative sentinel nodes (SNs) have varying outcomes, dependent on several prognostic factors. Considering all these factors in a prediction model might aid in identifying patients who could benefit from a personalized treatment strategy. The objective was to construct and validate a nomogram for recurrence and melanoma-specific mortality (MSM) in patients with melanoma and negative SNs.
METHODS
A total of 3220 patients with negative SNs were identified from a cohort of 4124 patients from four EORTC Melanoma Group centres who underwent sentinel lymph node biopsy. Prognostic factors for recurrence and MSM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c-index) and calibration in cross-validation across the four centres. A nomogram was developed for graphical presentation.
RESULTS
There were 3180 eligible patients. The final prediction model for recurrence and the calibrated model for MSM included three independent prognostic factors: ulceration, anatomical location and Breslow thickness. The c-index was 0·74 for recurrence and 0·76 for the calibrated MSM model. Cross-validation across the four centres showed reasonable model performance. A nomogram was developed based on these models. One-third of the patients had a 5-year recurrence probability of 8·2 per cent or less, and one-third had a recurrence probability of 23·0 per cent or more.
CONCLUSION
A nomogram for predicting recurrence and MSM in patients with melanoma and negative SNs was constructed and validated. It could provide personalized estimates useful for tailoring surveillance strategies (reduce or increase intensity), and selection of patients for adjuvant therapy or clinical trials.
Identifiants
pubmed: 30307046
doi: 10.1002/bjs.10995
pmc: PMC6585628
doi:
Types de publication
Journal Article
Multicenter Study
Validation Study
Langues
eng
Pagination
217-225Informations de copyright
© 2018 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.
Références
Br J Surg. 2008 Nov;95(11):1401-7
pubmed: 18844268
J Clin Oncol. 2011 Jun 1;29(16):2199-205
pubmed: 21519009
J Cutan Med Surg. 2018 Jan/Feb;22(1):14-21
pubmed: 28689448
CA Cancer J Clin. 2016 Sep;66(5):370-4
pubmed: 26784705
Stat Med. 1996 Feb 28;15(4):361-87
pubmed: 8668867
Methods Mol Biol. 2014;1102:275-86
pubmed: 24258984
Eur J Cancer. 2016 Aug;63:201-17
pubmed: 27367293
N Engl J Med. 2014 Feb 13;370(7):599-609
pubmed: 24521106
J Clin Oncol. 2001 Aug 15;19(16):3635-48
pubmed: 11504745
J Clin Oncol. 2009 Dec 20;27(36):6199-206
pubmed: 19917835
Ann Surg Oncol. 2018 Aug;25(8):2172-2177
pubmed: 29470818
Ann Surg Oncol. 2016 Sep;23(9):2753-61
pubmed: 27052645
J Am Coll Surg. 2012 Apr;214(4):608-17; discussion 617-9
pubmed: 22342785
Ann Surg Oncol. 2010 Aug;17(8):2006-14
pubmed: 20379784
Ann Surg Oncol. 2016 Sep;23(9):2762-71
pubmed: 27194552
N Engl J Med. 2017 Nov 9;377(19):1824-1835
pubmed: 28891423
J Pathol. 2003 Jul;200(3):314-9
pubmed: 12845627
Eur J Cancer. 2016 Nov;67:164-173
pubmed: 27669503
N Engl J Med. 2016 Nov 10;375(19):1845-1855
pubmed: 27717298
N Engl J Med. 2017 Nov 9;377(19):1813-1823
pubmed: 28891408
J Clin Epidemiol. 2016 Jan;69:245-7
pubmed: 25981519
N Engl J Med. 2017 Jun 8;376(23):2211-2222
pubmed: 28591523
Ann Surg Oncol. 2017 Jan;24(1):142-149
pubmed: 27646020
N Engl J Med. 2018 May 10;378(19):1789-1801
pubmed: 29658430
BMC Cancer. 2016 Jul 07;16:413
pubmed: 27389173
J Clin Oncol. 2001 Aug 15;19(16):3622-34
pubmed: 11504744
Arch Surg. 1992 Apr;127(4):392-9
pubmed: 1558490
Br J Dermatol. 2018 Feb;178(2):357-362
pubmed: 28386936
J Clin Oncol. 2010 Jun 20;28(18):3042-7
pubmed: 20479405
CA Cancer J Clin. 2017 Nov;67(6):472-492
pubmed: 29028110
J Clin Oncol. 2008 Mar 10;26(8):1364-70
pubmed: 18323559
Ann Surg Oncol. 2017 Apr;24(4):939-946
pubmed: 27804026
Surgery. 2016 May;159(5):1412-21
pubmed: 26775577
Lancet Oncol. 2016 Jun;17(6):757-767
pubmed: 27161539