Abstract
Background
In the current era of effective adjuvant therapies and de-escalation of surgery, distinguishing which patients with high-risk stage II melanoma are at increased risk of recurrence after excision of the primary lesion is essential to determining appropriate treatment and surveillance plans.
Methods
A single-center retrospective study analyzed patients with stage IIB or IIC melanoma. Demographic and tumor data were collected, and genomic analysis of formalin-fixed, paraffin-embedded tissue samples was performed via an internal next-generation sequencing (NGS) platform (SNaPshot). The end points examined were relapse-free survival (RFS), distant metastasis-free survival (DMFS), overall survival (OS), and melanoma-specific survival (MSS). Uni- and multivariable Cox regressions were performed to calculate the hazard ratios.
Results
The study included 92 patients with a median age of 69 years and a male/female ratio of 2:1. A Breslow depth greater than 4 mm, a higher mitotic rate, an advanced T stage, and a KIT mutation had a negative impact on RFS. A primary lesion in the head and neck, a mitotic rate exceeding 10 mitoses per mm2, a CDH1 mutation, or a KIT mutation was significantly associated with a shorter DMFS. Overall survival was significantly lower with older age at diagnosis and a higher mitotic rate. An older age at diagnosis also had a negative impact on MSS.
Conclusion
Traditional histopathologic factors and specific tumor mutations displayed a significant correlation with disease recurrence and survival for patients with high-risk stage II melanoma. This study supported the use of genomic testing of high-risk stage II melanomas for prognostic prediction and risk stratification.
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Details
1 Massachusetts General Hospital, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Boston, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924); Harvard Medical School, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, USA (GRID:grid.66859.34) (ISNI:0000 0004 0546 1623)
2 City of Hope National Medical Center, Division of Surgical Oncology, Duarte, USA (GRID:grid.410425.6) (ISNI:0000 0004 0421 8357)
3 Massachusetts General Hospital, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Boston, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924)
4 Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, USA (GRID:grid.66859.34) (ISNI:0000 0004 0546 1623); Dana-Farber Cancer Institute, Department of Medical Oncology, Center for Immuno-Oncology, Boston, USA (GRID:grid.65499.37) (ISNI:0000 0001 2106 9910)
5 Harvard University, Boston, USA (GRID:grid.38142.3c) (ISNI:0000 0004 1936 754X)
6 Massachusetts General Hospital, Cancer Center, Boston, USA (GRID:grid.32224.35) (ISNI:0000 0004 0386 9924)