Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
National Society for Cutaneous Medicine, New York, New York.
J Am Acad Dermatol. 2017 May;76(5):818-825.e3. doi: 10.1016/j.jaad.2016.11.051. Epub 2017 Jan 19.
A significant proportion of patients with American Joint Committee on Cancer (AJCC)-defined early-stage cutaneous melanoma have disease recurrence and die. A 31-gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described.
We sought to compare accuracy of the GEP in combination with risk determined using the web-based AJCC Individualized Melanoma Patient Outcome Prediction Tool.
GEP results from 205 stage I/II cutaneous melanomas with sufficient clinical data for prognostication using the AJCC tool were classified as low (class 1) or high (class 2) risk. Two 5-year overall survival cutoffs (AJCC 79% and 68%), reflecting survival for patients with stage IIA or IIB disease, respectively, were assigned for binary AJCC risk.
Cox univariate analysis revealed significant risk classification of distant metastasis-free and overall survival (hazard ratio range 3.2-9.4, P < .001) for both tools. In all, 43 (21%) cases had discordant GEP and AJCC classification (using 79% cutoff). Eleven of 13 (85%) deaths in that group were predicted as high risk by GEP but low risk by AJCC.
Specimens reflect tertiary care center referrals; more effective therapies have been approved for clinical use after accrual.
The GEP provides valuable prognostic information and improves identification of high-risk melanomas when used together with the AJCC online prediction tool.
相当一部分 AJCC 定义的早期皮肤黑色素瘤患者会出现疾病复发和死亡。已经描述了一种能够准确评估原发性皮肤黑色素瘤相关转移风险的 31 基因表达谱（GEP）。
我们旨在比较 GEP 与基于网络的 AJCC 个体化黑色素瘤患者预后预测工具联合使用时的准确性。
对 205 例 I/II 期皮肤黑色素瘤患者的 GEP 结果进行分析，这些患者具有足够的临床数据，可使用 AJCC 工具进行预后判断。根据 AJCC 工具，将 GEP 结果分为低风险（1 类）或高风险（2 类）。分别为两个 5 年总生存率截断值（AJCC 为 79%和 68%），分别反映 IIA 期或 IIB 期疾病患者的生存率，用于 AJCC 风险的二分类。
Cox 单因素分析显示，两种工具均能显著对远处无转移生存率和总生存率进行风险分类（危险比范围为 3.2-9.4，P<.001）。共有 43 例（21%）患者的 GEP 和 AJCC 分类不一致（使用 79%的截断值）。在该组中，13 例死亡患者中有 11 例（85%）的 GEP 预测为高风险，但 AJCC 预测为低风险。
标本反映了三级医疗中心的转诊情况；在入组后，更多有效的治疗方法已被批准用于临床。
当与 AJCC 在线预测工具一起使用时，GEP 可提供有价值的预后信息，并能更好地识别高危黑色素瘤。
