Abstract
Very rapid progression of disease with a median survival of 6-9 months is a common feature of metastatic cutaneous malignant melanoma. Nevertheless, substantial variability of survival suggests that metastatic cutaneous malignant melanoma can be divided into several biological subgroups. Pretreatment serum levels of soluble adhesion molecules and various clinical parameters in cutaneous metastatic malignant melanoma were evaluated to determine their prognostic value. In this study pretreatment serum levels of soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble intercellular cell adhesion molecule 1 (sICAM-1), soluble endothelial leukocyte adhesion molecule 1 (sE-selectin) and multiple clinical factors were assessed in relation to overall survival of 97 consecutive patients with metastatic cutaneous malignant melanoma seen at our institution between May 1990 and April 1996. For statistical analysis, both univariate and multivariate Cox proportional-hazards models were used. Elevated pretreatment serum levels of sVCAM-1 (P < 0.005) and of lactate dehydrogenase (P < 0.002) were rendered statistically independent and were significantly associated with unfavourable outcome. Patients were assigned to one of three risk categories (low, intermediate and high) according to a cumulative risk score defined as the function of the sum of these two variables. There were significant differences in overall survival (P < 0.0001) between low- (n = 53, 5-year survival probability of 23.3%), intermediate- (n = 29, 5-year survival probability of 9.9%) and high-risk (n = 15) patients. Elevated pretreatment serum levels of sVCAM-1 and of lactate dehydrogenase correlate with poor outcome in metastatic cutaneous malignant melanoma. These data support risk stratification for future therapeutic trials and identify factors that need to be validated in prospective studies and may potentially influence decision-making in palliative management of patients with disseminated cutaneous malignant melanoma.
Highlights
We evaluated the prognostic value of elevated serum levels of soluble adhesion molecules sVCAM- 1. sICAM- 1. sE-selectin and of multiple clinical parameters in relation to overall survival in 97 consecutive patients with metastatic malignant melanoma using univariate and multivariate Cox proportional-hazards models
We analysed the ability of various clinical factors and of levels of soluble adhesion molecules to predict clinical outcome
Elevated serum levels of lactate dehydrogenase (LDH) (> 240 U 1-') were present in 39 patients and were strongly associated with an unfavourable outcome: median survival in these patients was 5 months as opposed to patients with normal serum LDH (n = 58). who had a median survival of 16 months
Summary
The purpose of this study was to identify prognostic factors for survival that may allow appropriate stratification in the management of metastatic malignant melanoma both in and outside clinical trials
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