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

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., Jul-2020, In : European Journal of Cancer. 134, p. 9-18 10 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • 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

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 EORTCDeCOG 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

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. (C) 2020 The Author(s). Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)9-18
Number of pages10
JournalEuropean Journal of Cancer
Volume134
Early online date2020
Publication statusPublished - 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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