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. 2021 Apr 10;39(11):1243-1252.
doi: 10.1200/JCO.20.02446. Epub 2021 Feb 18.

Development and Validation of Nomograms to Predict Local, Regional, and Distant Recurrence in Patients With Thin (T1) Melanomas

Mary-Ann El Sharouni  1   2 , Tasnia Ahmed  1 , Alexander H R Varey  1   3   4 , Sjoerd G Elias  5 , Arjen J Witkamp  6 , Vigfús Sigurdsson  2 , Karijn P M Suijkerbuijk  7 , Paul J van Diest  8 , Richard A Scolyer  1   3   9 , Carla H van Gils  5 , John F Thompson  1   3   10 , Willeke A M Blokx  8 , Serigne N Lo  1   3
Affiliations

Development and Validation of Nomograms to Predict Local, Regional, and Distant Recurrence in Patients With Thin (T1) Melanomas

Mary-Ann El Sharouni et al. J Clin Oncol. .

Abstract

Purpose: Although the prognosis of patients with thin primary cutaneous melanomas (T1, ≤ 1.0 mm) is generally excellent, some develop recurrence. We sought to develop and validate a model predicting recurrences in patients with thin melanomas.

Methods: A Dutch population-based cohort (n = 25,930, development set) and a cohort from an Australian melanoma treatment center (n = 2,968, validation set) were analyzed (median follow-up 6.7 and 12.0 years, respectively). Multivariable Cox models were generated for local, regional, and distant recurrence-free survival (RFS). Discrimination was assessed using Harrell's C-statistic for each outcome. Each nomogram performance was evaluated using calibration plots defining low-risk and high-risk groups as the lowest and top 5% of the nomogram risk score, respectively. The nomograms' C-statistics were compared with those of a model including the current American Joint Committee on Cancer staging parameters (T-stage and sentinel node status).

Results: Local, regional, and distant recurrences were found in 209 (0.8%), 503 (1.9%), and 203 (0.8%) Dutch patients, respectively, and 23 (0.8%), 61 (2.1%), and 75 (2.5%) Australian patients, respectively. C-statistics of 0.79 (95% CI, 0.75 to 0.82) for local RFS, 0.77 (95% CI, 0.75 to 0.78) for regional RFS, and 0.80 (95% CI, 0.77 to 0.83) for distant RFS were obtained for the development model. External validation showed C-statistics of 0.80 (95% CI, 0.69 to 0.90), 0.76 (95% CI, 0.70 to 0.82), and 0.74 (95% CI, 0.69 to 0.80), respectively. Calibration plots showed a good match between predicted and observed rates. Using the nomogram, the C-statistic was increased by 9%-12% for the development cohort and by 11%-15% for the validation cohort, compared with a model including only T-stage and sentinel node status.

Conclusion: Most patients with thin melanomas have an excellent prognosis, but some develop recurrence. The presented nomograms can accurately identify a subgroup at high risk. An online calculator is available at www.melanomarisk.org.au.

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Conflict of interest statement

Alexander H. R. VareyConsulting or Advisory Role: MedtronicTravel, Accommodations, Expenses: Synthes Karijn P. M. SuijkerbuijkConsulting or Advisory Role: Bristol-Myers Squibb, Novartis, MSD, Pierre FabreSpeakers' Bureau: Roche, NovartisTravel, Accommodations, Expenses: Roche, MSD Paul J. van DiestConsulting or Advisory Role: Pantarhei BiosciencePatents, Royalties, Other Intellectual Property: DDX3 as a biomarker for cancer and methods related thereto Richard A. ScolyerEmployment: Royal Prince Alfred HospitalConsulting or Advisory Role: Bristol-Myers Squibb, GlaxoSmithKline, Merck Sharp & Dohme, NeraCare GmbH, Novartis Australia, Amgen, Myriad Genetics, MSD Sharp & Dohme (Australia) Pty Limited, Novartis, QBioticsResearch Funding: The Ainsworth Foundation, National Health and Medical Research CouncilTravel, Accommodations, Expenses: Bristol-Myers Squibb, Novartis Australia Carla H. van GilsConsulting or Advisory Role: BayerSpeakers' Bureau: BayerResearch Funding: BayerTravel, Accommodations, Expenses: Bayer John F. ThompsonHonoraria: GlaxoSmithKline, Bristol-Myers Squibb, MSD Australia, ProvectusConsulting or Advisory Role: GlaxoSmithKline, Bristol-Myers Squibb, MSD Australia, ProvectusTravel, Accommodations, Expenses: Provectus, GlaxoSmithKlineNo other potential conflicts of interest were reported.

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