TY - JOUR
T1 - Prognostic Significance of Mitotic Rate in Localized Primary Cutaneous Melanoma: An Analysis of Patients in the Multi-Institutional American Joint Committee on Cancer Melanoma Staging Database
AU - Thompson, JF
AU - Soong, SJ
AU - Balch, CM
AU - Gershenwald, JE
AU - Ding, SL
AU - Coit, DG
AU - Flaherty, KT
AU - Gimotty, PA
AU - Johnson, T
AU - Johnson, MM
AU - Leong, SP
AU - Ross, MI
AU - Byrd, DR
AU - Cascinelli, N
AU - Cochran, AJ
AU - Eggermont, Lex
AU - McMasters, KM
AU - Mihm, MC
AU - Morton, DL
AU - Sondak, VK
PY - 2011
Y1 - 2011
N2 - Purpose The aim of this study was to assess the independent prognostic value of primary tumor mitotic rate compared with other clinical and pathologic features of stages I and II melanoma. Methods From the American Joint Committee on Cancer (AJCC) melanoma staging database, information was extracted for 13,296 patients with stages I and II disease who had mitotic rate data available. Results Survival times declined as mitotic rate increased. Ten-year survival ranged from 93% for patients whose tumors had 0 mitosis/mm(2) to 48% for those with >= 20/mm(2) (P < .001). Mean number of mitoses/mm(2) increased as the primary melanomas became thicker (1.0 for melanomas <= 1 mm, 3.5 for 1.01 to 2.0 mm, 7.3 for 3.01 to 4.0 mm, and 9.6 for > 8 mm). Ulceration was also associated with a higher mitotic rate; 59% of ulcerated melanomas had >= 5 mitoses/mm(2) compared with 16% of nonulcerated melanomas (P < .001). In a multivariate analysis of 10,233 patients, the independent predictive factors for survival in order of statistical significance were as follows: tumor thickness (chi(2) = 104.9; P < .001), mitotic rate (chi(2) = 67.0; P < .001), patient age (chi(2) = 48.2; P < .001), ulceration (chi(2) = 46.4; P < .001), anatomic site (chi(2) = 34.6; P < .001), and patient sex (chi(2) = 33.9; P < .001). Clark level of invasion was not an independent predictor of survival (chi(2) = 3.2; P = .37). Conclusion A high mitotic rate in a primary melanoma is associated with a lower survival probability. Among the independent predictors of melanoma-specific survival, mitotic rate was the strongest prognostic factor after tumor thickness. J Clin Oncol 29: 2199-2205. (C) 2011 by American Society of Clinical Oncology
AB - Purpose The aim of this study was to assess the independent prognostic value of primary tumor mitotic rate compared with other clinical and pathologic features of stages I and II melanoma. Methods From the American Joint Committee on Cancer (AJCC) melanoma staging database, information was extracted for 13,296 patients with stages I and II disease who had mitotic rate data available. Results Survival times declined as mitotic rate increased. Ten-year survival ranged from 93% for patients whose tumors had 0 mitosis/mm(2) to 48% for those with >= 20/mm(2) (P < .001). Mean number of mitoses/mm(2) increased as the primary melanomas became thicker (1.0 for melanomas <= 1 mm, 3.5 for 1.01 to 2.0 mm, 7.3 for 3.01 to 4.0 mm, and 9.6 for > 8 mm). Ulceration was also associated with a higher mitotic rate; 59% of ulcerated melanomas had >= 5 mitoses/mm(2) compared with 16% of nonulcerated melanomas (P < .001). In a multivariate analysis of 10,233 patients, the independent predictive factors for survival in order of statistical significance were as follows: tumor thickness (chi(2) = 104.9; P < .001), mitotic rate (chi(2) = 67.0; P < .001), patient age (chi(2) = 48.2; P < .001), ulceration (chi(2) = 46.4; P < .001), anatomic site (chi(2) = 34.6; P < .001), and patient sex (chi(2) = 33.9; P < .001). Clark level of invasion was not an independent predictor of survival (chi(2) = 3.2; P = .37). Conclusion A high mitotic rate in a primary melanoma is associated with a lower survival probability. Among the independent predictors of melanoma-specific survival, mitotic rate was the strongest prognostic factor after tumor thickness. J Clin Oncol 29: 2199-2205. (C) 2011 by American Society of Clinical Oncology
U2 - 10.1200/JCO.2010.31.5812
DO - 10.1200/JCO.2010.31.5812
M3 - Article
C2 - 21519009
SN - 0732-183X
VL - 29
SP - 2199
EP - 2205
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 16
ER -
