The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection

Daniëlle Verver; A Rekkas; Claus Garbe; David van Klaveren; Alexander C J van Akkooi; Piotr Rutkowski; Barry W E M Powell; Caroline Robert; Alessandro Testori; Barbara L van Leeuwen; Astrid A M van der Veldt; Ulrich Keilholz; Rudolf Stadler; Alexander M M Eggermont; Cornelis Verhoef; Ulrike Leiter; Dirk J Grünhagen

doi:10.1016/j.ejca.2020.04.022

The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection

Daniëlle Verver^*, A Rekkas, Claus Garbe, David van Klaveren, Alexander C J van Akkooi, Piotr Rutkowski, Barry W E M Powell, Caroline Robert, Alessandro Testori, Barbara L van Leeuwen, Astrid A M van der Veldt, Ulrich Keilholz, Rudolf Stadler, Alexander M M Eggermont, Cornelis Verhoef, Ulrike Leiter, Dirk J Grünhagen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Purpose: Based on recent advances in the management of patients with sentinel node (SN)–positive melanoma, we aimed to develop prediction models for recurrence, distant metastasis (DM) and overall mortality (OM). Methods: The derivation cohort consisted of 1080 patients with SN-positive melanoma from nine European Organization for Research and Treatment of Cancer (EORTC) centres. Prognostic factors for recurrence, DM and OM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c-index) and calibration in cross-validation across centres. The models were externally validated using a prospective cohort consisting of 705 German patients with SN-positive: 473 trial participants of the German Dermatologic Cooperative Oncology Group study (DeCOG-SLT) and 232 screened patients. A nomogram was developed for graphical presentation. Results: The final model for recurrence and the calibrated models for DM and OM included ulceration, age, SN tumour burden and Breslow thickness. The models showed reasonable calibration. The c-index for the recurrence, DM and OM model was 0.68, 0.70 and 0.70, respectively, and 0.70, 0.72 and 0.74, respectively, in external validation. The EORTC-DeCOG model identified a robust low-risk group, with all identified low-risk patients (approximately 4% of the entire population) having a 5-year recurrence probability of <25% and an overall 5-year recurrence rate of 13%. A model including information on completion lymph node dissection (CLND) showed only marginal improvement in model performance. Conclusions: The EORTC-DeCOG nomogram provides an adequate prognostic tool for patients with SN-positive melanoma, without the need for CLND. It showed consistent results across validation. The nomogram could be used for patient counselling and might aid in adjuvant therapy decision-making.

Original language	English
Pages (from-to)	9-18
Number of pages	10
Journal	European Journal of Cancer
Volume	134
Early online date	2020
DOIs	https://doi.org/10.1016/j.ejca.2020.04.022
Publication status	Published - Jul-2020

Keywords

Melanoma
Sentinel lymph node
Nomogram
Prognosis
Adjuvant therapy
RESECTED STAGE-III
ADJUVANT THERAPY
CUTANEOUS MELANOMA
TUMOR BURDEN
BIOPSY
SURVIVAL
INTERFERON-ALPHA-2B
MULTICENTER
IPILIMUMAB
INTERVAL

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The EORTC-DeCOG nomogram adequately predictsoutcomes of patients with sentinel nodeepositivemelanoma without the need for completion lymph nodedissectionFinal publisher's version, 5.65 MBLicence: CC BY

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Verver, D., Rekkas, A., Garbe, C., van Klaveren, D., van Akkooi, A. C. J., Rutkowski, P., Powell, B. W. E. M., Robert, C., Testori, A., van Leeuwen, B. L., van der Veldt, A. A. M., Keilholz, U., Stadler, R., Eggermont, A. M. M., Verhoef, C., Leiter, U., & Grünhagen, D. J. (2020). The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection. European Journal of Cancer, 134, 9-18. https://doi.org/10.1016/j.ejca.2020.04.022

@article{60b9f3e078f34f2baba8e28fcb0072fe,

title = "The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection",

abstract = "Purpose: Based on recent advances in the management of patients with sentinel node (SN)–positive melanoma, we aimed to develop prediction models for recurrence, distant metastasis (DM) and overall mortality (OM). Methods: The derivation cohort consisted of 1080 patients with SN-positive melanoma from nine European Organization for Research and Treatment of Cancer (EORTC) centres. Prognostic factors for recurrence, DM and OM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c-index) and calibration in cross-validation across centres. The models were externally validated using a prospective cohort consisting of 705 German patients with SN-positive: 473 trial participants of the German Dermatologic Cooperative Oncology Group study (DeCOG-SLT) and 232 screened patients. A nomogram was developed for graphical presentation. Results: The final model for recurrence and the calibrated models for DM and OM included ulceration, age, SN tumour burden and Breslow thickness. The models showed reasonable calibration. The c-index for the recurrence, DM and OM model was 0.68, 0.70 and 0.70, respectively, and 0.70, 0.72 and 0.74, respectively, in external validation. The EORTC-DeCOG model identified a robust low-risk group, with all identified low-risk patients (approximately 4% of the entire population) having a 5-year recurrence probability of <25% and an overall 5-year recurrence rate of 13%. A model including information on completion lymph node dissection (CLND) showed only marginal improvement in model performance. Conclusions: The EORTC-DeCOG nomogram provides an adequate prognostic tool for patients with SN-positive melanoma, without the need for CLND. It showed consistent results across validation. The nomogram could be used for patient counselling and might aid in adjuvant therapy decision-making.",

keywords = "Melanoma, Sentinel lymph node, Nomogram, Prognosis, Adjuvant therapy, RESECTED STAGE-III, ADJUVANT THERAPY, CUTANEOUS MELANOMA, TUMOR BURDEN, BIOPSY, SURVIVAL, INTERFERON-ALPHA-2B, MULTICENTER, IPILIMUMAB, INTERVAL",

author = "Dani{\"e}lle Verver and A Rekkas and Claus Garbe and {van Klaveren}, David and {van Akkooi}, {Alexander C J} and Piotr Rutkowski and Powell, {Barry W E M} and Caroline Robert and Alessandro Testori and {van Leeuwen}, {Barbara L} and {van der Veldt}, {Astrid A M} and Ulrich Keilholz and Rudolf Stadler and Eggermont, {Alexander M M} and Cornelis Verhoef and Ulrike Leiter and Gr{\"u}nhagen, {Dirk J}",

year = "2020",

month = jul,

doi = "10.1016/j.ejca.2020.04.022",

language = "English",

volume = "134",

pages = "9--18",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "ELSEVIER SCI LTD",

}

Verver, D, Rekkas, A, Garbe, C, van Klaveren, D, van Akkooi, ACJ, Rutkowski, P, Powell, BWEM, Robert, C, Testori, A, van Leeuwen, BL, van der Veldt, AAM, Keilholz, U, Stadler, R, Eggermont, AMM, Verhoef, C, Leiter, U & Grünhagen, DJ 2020, 'The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection', European Journal of Cancer, vol. 134, pp. 9-18. https://doi.org/10.1016/j.ejca.2020.04.022

TY - JOUR

T1 - The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection

AU - Verver, Daniëlle

AU - Rekkas, A

AU - Garbe, Claus

AU - van Klaveren, David

AU - van Akkooi, Alexander C J

AU - Rutkowski, Piotr

AU - Powell, Barry W E M

AU - Robert, Caroline

AU - Testori, Alessandro

AU - van Leeuwen, Barbara L

AU - van der Veldt, Astrid A M

AU - Keilholz, Ulrich

AU - Stadler, Rudolf

AU - Eggermont, Alexander M M

AU - Verhoef, Cornelis

AU - Leiter, Ulrike

AU - Grünhagen, Dirk J

PY - 2020/7

Y1 - 2020/7

N2 - Purpose: Based on recent advances in the management of patients with sentinel node (SN)–positive melanoma, we aimed to develop prediction models for recurrence, distant metastasis (DM) and overall mortality (OM). Methods: The derivation cohort consisted of 1080 patients with SN-positive melanoma from nine European Organization for Research and Treatment of Cancer (EORTC) centres. Prognostic factors for recurrence, DM and OM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c-index) and calibration in cross-validation across centres. The models were externally validated using a prospective cohort consisting of 705 German patients with SN-positive: 473 trial participants of the German Dermatologic Cooperative Oncology Group study (DeCOG-SLT) and 232 screened patients. A nomogram was developed for graphical presentation. Results: The final model for recurrence and the calibrated models for DM and OM included ulceration, age, SN tumour burden and Breslow thickness. The models showed reasonable calibration. The c-index for the recurrence, DM and OM model was 0.68, 0.70 and 0.70, respectively, and 0.70, 0.72 and 0.74, respectively, in external validation. The EORTC-DeCOG model identified a robust low-risk group, with all identified low-risk patients (approximately 4% of the entire population) having a 5-year recurrence probability of <25% and an overall 5-year recurrence rate of 13%. A model including information on completion lymph node dissection (CLND) showed only marginal improvement in model performance. Conclusions: The EORTC-DeCOG nomogram provides an adequate prognostic tool for patients with SN-positive melanoma, without the need for CLND. It showed consistent results across validation. The nomogram could be used for patient counselling and might aid in adjuvant therapy decision-making.

AB - Purpose: Based on recent advances in the management of patients with sentinel node (SN)–positive melanoma, we aimed to develop prediction models for recurrence, distant metastasis (DM) and overall mortality (OM). Methods: The derivation cohort consisted of 1080 patients with SN-positive melanoma from nine European Organization for Research and Treatment of Cancer (EORTC) centres. Prognostic factors for recurrence, DM and OM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c-index) and calibration in cross-validation across centres. The models were externally validated using a prospective cohort consisting of 705 German patients with SN-positive: 473 trial participants of the German Dermatologic Cooperative Oncology Group study (DeCOG-SLT) and 232 screened patients. A nomogram was developed for graphical presentation. Results: The final model for recurrence and the calibrated models for DM and OM included ulceration, age, SN tumour burden and Breslow thickness. The models showed reasonable calibration. The c-index for the recurrence, DM and OM model was 0.68, 0.70 and 0.70, respectively, and 0.70, 0.72 and 0.74, respectively, in external validation. The EORTC-DeCOG model identified a robust low-risk group, with all identified low-risk patients (approximately 4% of the entire population) having a 5-year recurrence probability of <25% and an overall 5-year recurrence rate of 13%. A model including information on completion lymph node dissection (CLND) showed only marginal improvement in model performance. Conclusions: The EORTC-DeCOG nomogram provides an adequate prognostic tool for patients with SN-positive melanoma, without the need for CLND. It showed consistent results across validation. The nomogram could be used for patient counselling and might aid in adjuvant therapy decision-making.

KW - Melanoma

KW - Sentinel lymph node

KW - Nomogram

KW - Prognosis

KW - Adjuvant therapy

KW - RESECTED STAGE-III

KW - ADJUVANT THERAPY

KW - CUTANEOUS MELANOMA

KW - TUMOR BURDEN

KW - BIOPSY

KW - SURVIVAL

KW - INTERFERON-ALPHA-2B

KW - MULTICENTER

KW - IPILIMUMAB

KW - INTERVAL

U2 - 10.1016/j.ejca.2020.04.022

DO - 10.1016/j.ejca.2020.04.022

M3 - Article

C2 - 32454396

SN - 0959-8049

VL - 134

SP - 9

EP - 18

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection

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Keywords

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