Improved Risk Prediction Calculator for Sentinel Node Positivity in Patients With Melanoma: The Melanoma Institute Australia Nomogram

被引:125
作者
Lo, Serigne N. [1 ,2 ]
Ma, Jiawen [1 ,2 ]
Scolyer, Richard A. [1 ,2 ,3 ]
Haydu, Lauren E. [4 ]
Stretch, Jonathan R. [1 ,2 ,5 ,6 ]
Saw, Robyn P. M. [1 ,2 ,5 ,6 ]
Nieweg, Omgo E. [1 ,2 ,5 ,6 ]
Shannon, Kerwin F. [1 ,5 ,6 ]
Spillane, Andrew J. [1 ,2 ,7 ]
Ch'ng, Sydney [1 ,2 ,5 ,6 ]
Mann, Graham J. [1 ,2 ,8 ]
Gershenwald, Jeffrey E. [4 ]
Thompson, John F. [1 ,2 ,5 ,6 ]
Varey, Alexander H. R. [1 ,2 ,9 ]
机构
[1] Univ Sydney, Melanoma Inst Australia, Sydney, NSW, Australia
[2] Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia
[3] Royal Prince Alfred Hosp, Dept Tissue Oncol & Diagnost Pathol, Camperdown, NSW, Australia
[4] Univ Texas MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USA
[5] Royal Prince Alfred Hosp, Dept Melanoma & Surg Oncol, Camperdown, NSW, Australia
[6] New South Wales Hlth Pathol, Sydney, NSW, Australia
[7] Royal North Shore & Mater Hosp, Dept Breast & Melanoma Surg, Sydney, NSW, Australia
[8] Australian Natl Univ, John Curtin Sch Med Res, Canberra, ACT, Australia
[9] Westmead Hosp, Dept Plast Surg, Westmead, NSW, Australia
基金
澳大利亚国家健康与医学研究理事会; 英国医学研究理事会; 美国国家卫生研究院;
关键词
STAGE-III; INCREMENTAL VALUE; ROC CURVE; BIOPSY; VALIDATION; IPILIMUMAB; EXPERIENCE; MANAGEMENT; MODELS;
D O I
10.1200/JCO.19.02362
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PURPOSE For patients with primary cutaneous melanoma, the risk of sentinel node (SN) metastasis varies according to several clinicopathologic parameters. Patient selection for SN biopsy can be assisted by National Comprehensive Cancer Network (NCCN) and ASCO/Society of Surgical Oncology (SSO) guidelines and the Memorial Sloan Kettering Cancer Center (MSKCC) online nomogram. We sought to develop an improved online risk calculator using alternative clinicopathologic parameters to more accurately predict SN positivity. PATIENTS AND METHODS Data from 3,477 patients with melanoma who underwent SN biopsy at Melanoma Institute Australia (MIA) were analyzed. A new nomogram was developed by replacing body site and Clark level from the MSKCC model with mitotic rate, melanoma subtype, and lymphovascular invasion. The predictive performance of the new nomogram was externally validated using data from The University of Texas MD Anderson Cancer Center (n = 3,496). RESULTS The MSKCC model receiver operating characteristic curve had a predictive accuracy of 67.7% (95% CI, 65.3% to 70.0%). The MIA model had a predictive accuracy of 73.9% (95% CI, 71.9% to 75.9%), a 9.2% increase in accuracy over the MSKCC model (P < .001). Among the 2,748 SN-negative patients, SN biopsy would not have been offered to 22.1%, 13.4%, and 12.4% based on the MIA model, the MSKCC model, and NCCN or ASCO/SSO criteria, respectively. External validation generated a C-statistic of 75.0% (95% CI, 73.2% to 76.7%). CONCLUSION A robust nomogram was developed that more accurately estimates the risk of SN positivity in patients with melanoma than currently available methods. The model only requires the input of 6 widely available clinicopathologic parameters. Importantly, the number of patients undergoing unnecessary SN biopsy would be significantly reduced compared with use of the MSKCC nomogram or the NCCN or ASCO/SSO guidelines, without losing sensitivity. An online calculator is available at www.melanomarisk.org.au.
引用
收藏
页码:2719 / +
页数:12
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