Number of primary melanomas is an independent predictor of survival in patients with metastatic melanoma

Authors

  • Rajmohan Murali MBBS, MD,

    Corresponding author
    1. Melanoma Institute Australia, Sydney, New South Wales, Australia
    2. Discipline of Pathology, The University of Sydney, Sydney, New South Wales, Australia
    3. Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    4. Department of Pathology; Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
    • Department of Pathology, and Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065

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    • Fax: (646) 888-2595

  • Philip T. Brown MBBS,

    1. Melanoma Institute Australia, Sydney, New South Wales, Australia
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  • Richard F. Kefford MBBS, PhD,

    1. Melanoma Institute Australia, Sydney, New South Wales, Australia
    2. Discipline of Medical Oncology, The University of Sydney, Sydney, New South Wales, Australia
    3. Westmead Millennium Institute, The University of Sydney, Sydney, New South Wales, Australia
    4. Westmead Hospital, Sydney, New South Wales, Australia
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  • Richard A. Scolyer MBBS, MD,

    1. Melanoma Institute Australia, Sydney, New South Wales, Australia
    2. Discipline of Pathology, The University of Sydney, Sydney, New South Wales, Australia
    3. Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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  • John F. Thompson MBBS, MD,

    1. Melanoma Institute Australia, Sydney, New South Wales, Australia
    2. Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    3. Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
    4. Mater Hospital, Sydney, New South Wales, Australia
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  • Michael B. Atkins MD,

    1. Melanoma Institute Australia, Sydney, New South Wales, Australia
    2. Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Georgina V. Long MBBS, PhD

    1. Melanoma Institute Australia, Sydney, New South Wales, Australia
    2. Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    3. Discipline of Medical Oncology, The University of Sydney, Sydney, New South Wales, Australia
    4. Westmead Hospital, Sydney, New South Wales, Australia
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  • This study was presented in part at the 2010 Annual Meeting of the American Society of Clinical Oncology; June 4-8, 2010; Chicago, IL.

Abstract

BACKGROUND:

A history of multiple primary melanomas (PMs) has been associated with improved survival in patients with early stage melanoma, but whether it also is correlated with survival in patients with metastatic melanoma is unknown. The authors sought to address the latter question in the current study.

METHODS:

Patients with metastatic melanoma diagnosed at the Melanoma Institute Australia between 1983 and 2008 were identified. Overall survival (OS) was calculated from date of first distant metastasis. Survival analysis was performed using the Kaplan-Meier method, log-rank tests, and multivariate Cox proportional hazards models.

RESULTS:

Of 2942 patients with metastatic melanoma, 2634 (89.5%) had 1 PM and 308 (10.5%) had >1 PM. Factors that were associated independently with shorter OS were site of metastasis, including the brain (hazard ratio [HR], 2.41; 95% confidence interval [CI], 2.07-2.81; P < .001) and nonlung viscera (HR, 1.92; 95% CI, 1.67-2.22; P < .001, vs lymph node/subcutaneous/soft tissue), age >60 years (HR, 1.23; 95% CI, 1.12-1.36; P < .001), shorter disease-free interval from PM to first distant metastasis (≤12 months vs >36 months: HR, 1.62; 95% CI, 1.39-1.89; P < .001), and fewer PMs (1 vs >1; HR, 1.26; 95% CI, 1.08-1.47; P = .004).

CONCLUSIONS:

A history of multiple PM was an independent predictor of improved survival for patients with metastatic melanoma. The results indicate that a history of multiple PMs should be incorporated into multivariate analyses of prognostic factors and treatment outcomes. Cancer 2012. © 2012 American Cancer Society.

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