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An Evidence-Based Staging System for Mucosal Melanoma: A Proposal

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is no widely employed staging system for mucosal melanoma (MuM) that incorporates all anatomic sites. We hypothesized that MuM patients arising from different anatomical sites could be staged using a common approach.

Methods

A prospective database contained 1814 MuM patients with a median follow-up of 5.14 years was employed. Overall survival (OS) was calculated from the time of pathological diagnosis to the date of death from any cause. Multivariate analyses of prognostic variables and OS were performed using the Cox proportional hazard model.

Results

For localized MuM, the most significant median OS differences were primary tumors invading submucosa (i.e., T1) versus deeper (i.e., T2/T3/T4): 4.3 versus 3.4, 3.1, and 2.9 years, respectively (p < 0.001). For patients only with regional node metastasis at presentation, the most significant were: 1 versus ≥ 2 regional nodes (N1 vs. N2, 2.5 vs. 2.1 years, p < 0.001). For patients with distant metastasis at presentation, the median OS was 1.5, 1.2, 0.8, and 0.6 years respectively for skin/subcutaneous tissue/distant lymph nodes (M1a), lung metastasis (M1b), all other visceral sites except brain (M1c), and brain (M1d) (p < 0.001). Based on these results, the staging system for MuM is proposed: (1) Stage I: T1N0M0 (median OS, 4.3 years); (2) Stage II: T2-4N0M0 (3.1 years); (3) Stage IIIA: T1-4N1M0 (2.5 years), Stage IIIB: T1-4N2M0 (2.1 years); (4) Stage IV: TanyNanyM1 (0.9 years) (p < 0.001).

Conclusions

A single, unified, staging system for mucosal melanoma inclusive of all anatomical primary tumor sites can harmonize staging of MuM and the design of clinical trials.

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Acknowledgments

The authors thank the patients and families for making this study possible. JEG gratefully acknowledges support by the Dr. John M. Skibber Endowed Professorship and the Michael and Patricia Booker Melanoma Research Endowment.

Funding

This work was supported by grants from National Natural Science Foundation of China (No. 81972562), Beijing Municipal Administration of Hospitals Incubating Program (Code: PX2017042, PX2021046), Beijing Municipal Administration of Hospitals’ Youth Programme (Code: QML20181101).

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Author notes

  1. ChuanLiang Cui and Bin Lian have contributed equally to this work and are the co-first authors.

Authors and Affiliations

  1. Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, 100142, China

    ChuanLiang Cui MD, Bin Lian MD, Lu Si MD, Yue Yang MD, Hui Tian MD, Li Zhou MD, ZhiHong Chi MD, XiNan Sheng MD, Yan Kong MD, LiLi Mao MD, Xuan Wang MD, Xue Bai MD, XieQiao Yan MD, SiMing Li MD, Jie Dai MD, BiXia Tang MD, Xiaoting Wei MD & Jun Guo MD, PhD

  2. Melanoma and Sarcoma Medical Oncology Unit, Biotherapy Center, SUN YAT-SEN University Cancer Center, Guangzhou, China

    XiaoShi Zhang MD

  3. Cancer center, The First Hospital of Jilin University, Changchun, China

    Di Wu MD

  4. Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, Kunming, China

    Ke Li MD

  5. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Jeffrey E. Gershenwald MD & Charles M. Balch MD

Authors
  1. ChuanLiang Cui MD
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Contributions

Conception and design: JG, CMB, CLC, BL, JEG. Provision of study materials or patients: CLC, BL, XSZ, DW, KL. Collection and assembly of data: JG, CLC, BL, XSZ, DW, KL, LS, YY, HT, LZ, ZHC, XNS, YK. Data analysis and interpretation: JG, CMB, CLC, BL, JEG. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors.

Corresponding author

Correspondence to Jun Guo MD, PhD.

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Disclosure

Dr. Jun Guo is the member of the advisory board/consultant of MSD, Roche, Pfizer, Bayer, Novartis, Simcere, Shanghai Junshi Bioscience, and Oriengene. Jeffrey E. Gershenwald has served as a consultant and/ or on advisory boards for Merck, Novartis, Bristol-Myers Squibb, Regeneron, Syndax, outside of the current work. Xue Bai declares a merit award supported by BMS. All remaining authors have declared no conflicts of interest.

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Cui, C., Lian, B., Zhang, X. et al. An Evidence-Based Staging System for Mucosal Melanoma: A Proposal. Ann Surg Oncol 29, 5221–5234 (2022). https://doi.org/10.1245/s10434-022-11670-6

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  • DOI: https://doi.org/10.1245/s10434-022-11670-6

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