Tumor Biology

, Volume 37, Issue 8, pp 10339–10348 | Cite as

Clinical characteristics and prognostic indicators for metastatic melanoma: data from 446 patients in north China

  • Mengze Hao
  • Gang Zhao
  • Xiaoling Du
  • Yun Yang
  • Jilong Yang
Original Article

Abstract

Melanoma is an extremely rare tumor in Asia. This retrospective study aimed to identify the clinical characteristics and prognostic factors of metastatic melanoma patients at Tianjin Medical University Cancer Hospital over the last 30 years. Survival analysis was performed with Kaplan-Meier, log-rank test, and multivariate Cox regression method using SPSS 19.0 software. The 1-, 2-, and 5-year survival rates of metastatic melanoma patients were 52, 32, and 16 %, respectively. Median overall survival (OS) was 13.5 months, median progression-free survival (PFS) 9.0 months, and median disease-free survival 20.3 months. Furthermore, patients with a single metastatic site achieved better OS and PFS than those with two or more metastatic lesions (OS 21.6 vs. 8.9 months, P < 0.001; PFS 11.3 vs. 7.1 months, P < 0.001). Survival times of patients with visceral metastases were the shortest (OS 8.5 months; PFS 7.5 months). Specifically, patients with primary mucosal lesions had a worse OS (9.7 months) and PFS (6.8 months) than those with acral (19.2 and 15.6 months, respectively) or non-acral primary lesions (11.8 and 11.1 months, respectively). The treatment of advanced melanoma was unitary, and prognoses of patients with metastatic melanoma in China were poor. Visceral metastasis, multiple metastatic sites, and primary mucosal lesions were significant predictors of survival of patients with metastatic melanoma. Those with primary mucosal lesions had significantly worse survivals than those with primary cutaneous lesions. More active involvement in clinical studies and more feedback on various treatment options are required.

Keywords

Metastatic melanoma Prognosis Predictor Overall survival Progression-free survival 

Notes

Acknowledgments

This work was partly supported by the National Nature Science Foundation of China (81372872 to J. Yang and 81402215 to X. Du), funds from the University Cancer Foundation via the Sister Institution Network Fund (SINF) at the Tianjin Medical University Cancer Institute and Hospital (TMUCIH), Fudan University Shanghai Cancer Center (FUSCC), and University of Texas MD Anderson Cancer Center (UT MDACC).

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Kosary CL, Altekruse SF, Ruhl J, Lee R, Dickie L. Clinical and prognostic factors for melanoma of the skin using seer registries: collaborative stage data collection system, version 1 and version 2. Cancer. 2014;120 Suppl 23:3807–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Korta DZ, Saggar V, Wu TP, Sanchez M. Racial differences in skin cancer awareness and surveillance practices at a public hospital dermatology clinic. J Am Acad Dermatol. 2014;70:312–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29.CrossRefPubMedGoogle Scholar
  4. 4.
    Coit DG, Thompson JA, Andtbacka R, Anker CJ, Bichakjian CK, Carson 3rd WE, et al. Melanoma, version 4. 2014. J Natl Compr Canc Netw. 2014;12:621–9.PubMedGoogle Scholar
  5. 5.
    Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, risk factors, pathogenesis, diagnosis and classification. In Vivo. 2014;28:1005–11.PubMedGoogle Scholar
  6. 6.
    Howlader N NA, Krapcho M, Neyman N, Aminou R, Waldron W, et al. editors. Available from: SEER cancer statistics review, 1975–2009, National Cancer Institute. Bethesda, md. Available from: http://seer.cancer.gov/csr/1975-2009-pops09/. 2013
  7. 7.
    Zhu H, Dong D, Li F, Liu D, Wang L, Fu J, et al. Clinicopathologic features and prognostic factors in patients with non-cutaneous malignant melanoma: s single-center retrospective study of 71 cases. Int J Dermatol. 2015;54(12):1390–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Song X, Zhao Z, Barber B, Farr AM, Ivanov B, Novich M. Overall survival in patients with metastatic melanoma. Curr Med Res Opin. 2015;31(5):987–91.Google Scholar
  9. 9.
    Zhong J, Zhou JN, Xu FP, Shang JQ. Diagnosis and treatment of anorectal malignant melanoma—a report of 22 cases with literature review. Chin J Cancer. 2006;25:619–24.Google Scholar
  10. 10.
    Debarbieux S, Duru G, Dalle S, Beatrix O, Balme B, Thomas L. Sentinel lymph node biopsy in melanoma: a micromorphometric study relating to prognosis and completion lymph node dissection. Br J Dermatol. 2007;157:58–67.CrossRefPubMedGoogle Scholar
  11. 11.
    Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bostanci O, Kartal K. Liver metastases of unknown primary. Malignant Melanoma. 2014;2014:131708.Google Scholar
  13. 13.
    Erez A, Shental O, Tchebiner JZ, Laufer-Perl M, Wasserman A, Sella T, et al. Diagnostic and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med Assoc J. 2014;16:439–43.PubMedGoogle Scholar
  14. 14.
    Akcay MN. Metastatic disease in the breast. Breast. 2002;11:526–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Moreno-Ramirez D, Ojeda-Vila T, Rios-Martin JJ, Nieto-Garcia A, Ferrandiz L. Role of age and sex in the diagnosis of early-stage malignant melanoma: a cross-sectional study. Acta Derm Venereol. 2015;95(8):940–2.CrossRefPubMedGoogle Scholar
  16. 16.
    Haas A, Pinter O, Papaefthymiou G, Weger M, Berghold A, Schrottner O, et al. Incidence of radiation retinopathy after high-dosage single-fraction gamma knife radiosurgery for choroidal melanoma. Ophthalmology. 2002;109:909–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Philippart P, da Costa PM, Heymans O, Pector JC, de Saint-Aubin N, Andry G. Metastatic involvement of ceco-appendicular segment: a diagnosis of right lower quadrant abdominal pain in patient receiving chemotherapy. Hepato-Gastroenterol. 2000;47:1627–9.Google Scholar
  18. 18.
    Avery-Kiejda KA, Bowden NA, Croft AJ, Scurr LL, Kairupan CF, Ashton KA, et al. P53 in human melanoma fails to regulate target genes associated with apoptosis and the cell cycle and may contribute to proliferation. BMC Cancer. 2011;11:203.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Cascinelli N, Heerlyn M, Schneeberger A, Kuwert C, Slominski A, Armstrong C, et al. What is the most promising strategy for the treatment of metastasizing melanoma? Exp Dermatol. 2000;9:439–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Chen W, Zheng R, Zhang S, Zhao P, Zeng H, Zou X. The incidences and mortalities of major cancers in China, 2010. Chin J Cancer. 2014;33(8):402–5.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Eggermont AM, Robert C. New drugs in melanoma: it’s a whole new world. Eur J Cancer. 2011;47:2150–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Jang S, Atkins MB. Which drug, and when, for patients with BRAF-mutant melanoma? Lancet Oncol. 2013;14:e60–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Cybulska-Stopa B, Skoczek M, Ziobro M, Switaj T, Falkowski S, Morysinski T, et al. Results of systemic treatment of cutaneous melanoma in inoperable stage iii and iv. Contemp Oncol (Pozn). 2012;16:532–45.Google Scholar
  24. 24.
    Sandru A, Voinea S, Panaitescu E, Blidaru A. Survival rates of patients with metastatic malignant melanoma. J Med Life. 2014;7:572–6.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Shields CL, Shields MV, Viloria V, Pearlstein H, Say EA, Shields JA. Iridocorneal endothelial syndrome masquerading as iris melanoma in 71 cases. Arch Ophthalmol. 2011;129:1023–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Chi Z, Li S, Sheng X, Si L, Cui C, Han M, et al. Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: a study of 522 consecutive cases. BMC Cancer. 2011;11:85.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lepper W, Shivalkar B, Rinkevich D, Belcik T, Wei K. Assessment of the vascularity of a left ventricular mass using myocardial contrast echocardiography. J Am Soc Echocardiogr. 2002;15:1419–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Fujii K, Komurasaki Y, Kanno Y, Ohgou N. Unilateral exophthalmos due to orbital metastasis from a contralateral intraocular melanoma. Eur J Dermatol. 1998;8:343–6.PubMedGoogle Scholar
  29. 29.
    Rutkowski P, Debiec-Rychter M, Ruka W. Gastrointestinal stromal tumors: key to diagnosis and choice of therapy. Mol Diagn Ther. 2008;12:131–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Dabouz F, Barbe C, Lesage C, Le Clainche A, Arnoult G, Hibon E, et al. Clinical and histological features of head and neck melanoma: a population-based study in France. Br J Dermatol. 2014;172(3):707–15.CrossRefGoogle Scholar
  31. 31.
    Andersen PS, Chakera AH, Thamsborg AK, Kolle SF, Schmidt G, Klyver H, et al. Recurrence and survival after neck dissections in cutaneous head and neck melanoma. Dan Med J. 2014;61:A4953.PubMedGoogle Scholar
  32. 32.
    Franzke A, Probst-Kepper M, Buer J, Duensing S, Hoffmann R, Wittke F, et al. Elevated pretreatment serum levels of soluble vascular cell adhesion molecule 1 and lactate dehydrogenase as predictors of survival in cutaneous metastatic malignant melanoma. Br J Cancer. 1998;78:40–5.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Schmidt H, Bastholt L, Geertsen P, Christensen IJ, Larsen S, Gehl J, et al. Elevated neutrophil and monocyte counts in peripheral blood are associated with poor survival in patients with metastatic melanoma: a prognostic model. Br J Cancer. 2005;93:273–8.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Pan Y, Haydon AM, McLean CA, McDonald PB, Kelly JW. Prognosis associated with cutaneous melanoma metastases. Australas J Dermatol. 2015;56:25–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Brand CU, Ellwanger U, Stroebel W, Meier F, Schlagenhauff B, Rassner G, et al. Prolonged survival of 2 years or longer for patients with disseminated melanoma. An analysis of related prognostic factors. Cancer. 1997;79:2345–53.CrossRefPubMedGoogle Scholar
  36. 36.
    Eton O, Legha SS, Moon TE, Buzaid AC, Papadopoulos NE, Plager C, et al. Prognostic factors for survival of patients treated systemically for disseminated melanoma. J Clin Oncol. 1998;16:1103–11.CrossRefPubMedGoogle Scholar
  37. 37.
    Manola J, Atkins M, Ibrahim J, Kirkwood J. Prognostic factors in metastatic melanoma: a pooled analysis of eastern cooperative oncology group trials. J Clin Oncol. 2000;18:3782–93.CrossRefPubMedGoogle Scholar
  38. 38.
    Bartlett EK, Karakousis GC. Current staging and prognostic factors in melanoma. Surg Oncol Clin N Am. 2015;24:215–27.CrossRefPubMedGoogle Scholar
  39. 39.
    Deichmann M, Benner A, Bock M, Jackel A, Uhl K, Waldmann V, et al. S100-beta, melanoma-inhibiting activity, and lactate dehydrogenase discriminate progressive from nonprogressive American Joint Committee on Cancer stage iv melanoma. J Clin Oncol. 1999;17:1891–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Diem S, Kasenda B, Martin-Liberal J, Lee A, Chauhan D, Gore M, et al. Prognostic score for patients with advanced melanoma treated with ipilimumab. Eur J Cancer. 2015;51:2785–91.CrossRefPubMedGoogle Scholar
  41. 41.
    Unger JM, Flaherty LE, Liu PY, Albain KS, Sondak VK. Gender and other survival predictors in patients with metastatic melanoma on southwest oncology group trials. Cancer. 2001;91:1148–55.CrossRefPubMedGoogle Scholar
  42. 42.
    Joosse A, Collette S, Suciu S, Nijsten T, Lejeune F, Kleeberg UR, et al. Superior outcome of women with stage i/ii cutaneous melanoma: pooled analysis of four European organisation for research and treatment of cancer phase iii trials. J Clin Oncol. 2012;30:2240–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Joosse A, Collette S, Suciu S, Nijsten T, Patel PM, Keilholz U, et al. Sex is an independent prognostic indicator for survival and relapse/progression-free survival in metastasized stage iii to iv melanoma: a pooled analysis of five European organisation for research and treatment of cancer randomized controlled trials. J Clin Oncol. 2013;31:2337–46.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2016

Authors and Affiliations

  • Mengze Hao
    • 1
    • 2
  • Gang Zhao
    • 2
    • 3
  • Xiaoling Du
    • 4
  • Yun Yang
    • 1
    • 2
  • Jilong Yang
    • 1
    • 2
  1. 1.Department of Bone and Soft Tissue TumorTianjin Medical University Cancer Hospital and InstituteTianjinChina
  2. 2.National Clinical Research Center for CancerTianjin Medical University Cancer Institute and HospitalTianjinChina
  3. 3.Department of PathologyTianjin Medical University Cancer Hospital and InstituteTianjinChina
  4. 4.Department of DiagnosticTianjin Medical UniversityTianjinChina

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