Characteristics of first relapse in stage III melanoma patients with no evidence of disease (NED): Guidelines for follow-up

Abstract

9069 Background: Follow up (F/U) of patients (pts) with AJCC stage III melanoma but with NED is currently empiric with respect to frequency of clinical exams, F/U duration, and diagnostic tests. Data-based F/U guidelines are needed. Methods: Clinical records of 429 pts with stage III NED pts seen at MSKCC between 1998 and 2002 and who ultimately relapsed were reviewed retrospectively to evaluate: site and date of 1st relapse, interval between the stage III NED and 1st relapse; how the 1st relapse was detected, date of death or last F/U. We also determined the overall 5 yr relapse-free survival (RFS) of all stage III pts seen at MSKCC during this period. Results: The overall 5 yr RFS for stage IIIA, B, and C patients at MSKCC was: 52%, 29%, and 15%, respectively. Among the relapsing pts, 280 had adequate F/U to be evaluable for all parameters (35 stage IIIA, 155 stage IIIB, 90 stage IIIC). The site of 1st relapse was local/in-transit (28%), regional nodal (20%), or systemic sites (52%). The most common sites of 1st systemic relapse were lung, liver, brain. There were significant differences among substages. First relapses were detected by the pt or family, MD, or by screening radiological tests in 52%, 19%, and 29% of cases, respectively. Multivariate analysis revealed better overall survival (OS) was not associated with time to relapse but was associated with younger age and if 1st relapse was: a) local/in-transit or nodal, b) asymptomatic, or c) resectable. By noting when the risk for 1st local/intransit, nodal, or systemic (lung, liver, brain) relapse became sufficiently low (<5%) for each substage, we generated tentative F/U guidelines ( Table ). Conclusions: Our data suggest that F/U strategies for stage III should be adapted by substage and indicate time ranges beyond which more prolonged F/U would be unlikely to benefit pts. Whether frequent F/U within these time ranges can increase the chances of complete surgical resection or improve OS is not known. [Table: see text] No significant financial relationships to disclose.