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. 2020 Jul:134:9-18.
doi: 10.1016/j.ejca.2020.04.022. Epub 2020 May 23.

The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection

Daniëlle Verver  1 , A Rekkas  2 , Claus Garbe  3 , David van Klaveren  4 , Alexander C J van Akkooi  5 , Piotr Rutkowski  6 , Barry W E M Powell  7 , Caroline Robert  8 , Alessandro Testori  9 , Barbara L van Leeuwen  10 , Astrid A M van der Veldt  11 , Ulrich Keilholz  12 , Rudolf Stadler  13 , Alexander M M Eggermont  14 , Cornelis Verhoef  15 , Ulrike Leiter  3 , Dirk J Grünhagen  15
Affiliations
Free article

The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection

Daniëlle Verver et al. Eur J Cancer. 2020 Jul.
Free article

Abstract

Purpose: Based on recent advances in the management of patients with sentinel node (SN)-positive melanoma, we aimed to develop prediction models for recurrence, distant metastasis (DM) and overall mortality (OM).

Methods: The derivation cohort consisted of 1080 patients with SN-positive melanoma from nine European Organization for Research and Treatment of Cancer (EORTC) centres. Prognostic factors for recurrence, DM and OM 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 centres. The models were externally validated using a prospective cohort consisting of 705 German patients with SN-positive: 473 trial participants of the German Dermatologic Cooperative Oncology Group study (DeCOG-SLT) and 232 screened patients. A nomogram was developed for graphical presentation.

Results: The final model for recurrence and the calibrated models for DM and OM included ulceration, age, SN tumour burden and Breslow thickness. The models showed reasonable calibration. The c-index for the recurrence, DM and OM model was 0.68, 0.70 and 0.70, respectively, and 0.70, 0.72 and 0.74, respectively, in external validation. The EORTC-DeCOG model identified a robust low-risk group, with all identified low-risk patients (approximately 4% of the entire population) having a 5-year recurrence probability of <25% and an overall 5-year recurrence rate of 13%. A model including information on completion lymph node dissection (CLND) showed only marginal improvement in model performance.

Conclusions: The EORTC-DeCOG nomogram provides an adequate prognostic tool for patients with SN-positive melanoma, without the need for CLND. It showed consistent results across validation. The nomogram could be used for patient counselling and might aid in adjuvant therapy decision-making.

Keywords: Adjuvant therapy; Melanoma; Nomogram; Prognosis; Sentinel lymph node.

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Conflict of interest statement

Conflict of interest statement D.V. has served in a consultancy/advisory role for Amgen, not related to this work. U.L. has served in a consultancy/advisory role for Pierre Fabre, Roche and Novartis and has received travel/accommodation expenses from Pierre Fabre and Novartis (all not related to this work). A.C.J.v.A. has served in a consultancy/advisory role for Amgen, Bristol-Meyers Squibb, Novartis, MSD-Merck, Merck-Pfizer and Roche and has received funding from Amgen and Novartis (all not related to this work). P.R. has received honoraria from BMS, Novartis, Roche, MSD and Amgen; has served in advisory role for Novartis, MSD, BMS, Pierre Fabre and Blueprint Medicines; has been a member of the speakers bureau of Pfizer and Pierre Fabre and has received research funding by the government (all not related to this work). C.R. has received honoraria from BMS, MSD, Novartis and Roche and Pierre Fabre and has served in advisory/consultancy role for BMS, MSD, Novartis, Roche and Pierre Fabre (all not related to this work). A.T. has received travel/accommodations expenses from Agenus (not related to this work). A.A.M.v.d.V. has received honoraria from MSD, BMS, Pfizer, Eisai, Roche, Novartis and Ipsen and has served as a consultant for MSD, BMS, Pfizer, Eisai, Roche, Novartis and Ipsen (all not related to this work). U.K. has received honoraria from AstraZeneca, BMS, Merck, Novartis and Pfizer; has served in consulting/advisory role for AstraZeneca, BMS and Merck; has been a member of the speakers bureau of AstraZeneca, BMS, Merck, Novartis and Pfizer; has received research funding from AstraZeneca and Pfizer and has received travel/accommodation expenses from AstraZeneca, BMS, Ipsen and Pfizer (all not related to this work). R.S. has received honoraria from Takeda, 4SC, Novartis, Roche and MSD; has served in advisory role for Takeda, 4SC, Novartis and Roche and has received research funding from the government (all not related to this work). C.G. has received honoraria from Amgen, BMS, MSD, Novartis, Philogen, Roche and Sanofi; has served in consulting/advisory role for Amgen, BMS, MSD, Novartis, Philogen, Roche and Sanofi; has received research funding from BMS, Novartis and Roche and has received travel/accommodation expenses from Amgen, BMS, MSD, NeraCare, Novartis, Philogen, Roche and Sanofi (all not related to this work). A.M.M.E. has received honoraria from Biocad, BMS, GSK, IO Biotech, MSD, Nektar, Novartis and Pfizer; has served in advisory/consultancy role for BMS, GSK, MSD, Novartis and Pfizer and has received travel/accommodation expenses from BMS and MSD (all not related to this work). D.J.G. has received honoraria from Amgen, BMS and Abbvie (all not related to this work). All other authors declare no competing interests.

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