Abstract
BackgroundThe objectives of this study were to evaluate and model the probability of melanoma-specific death and competing causes of death for patients with melanoma by competing risk analysis, and to build competing risk nomograms to provide individualized and accurate predictive tools.MethodsMelanoma data were obtained from the Surveillance Epidemiology and End Results program. All patients diagnosed with primary non-metastatic melanoma during the years 2004–2007 were potentially eligible for inclusion. The cumulative incidence function (CIF) was used to describe the probability of melanoma mortality and competing risk mortality. We used Gray’s test to compare differences in CIF between groups. The proportional subdistribution hazard approach by Fine and Gray was used to model CIF. We built competing risk nomograms based on the models that we developed.ResultsThe 5-year cumulative incidence of melanoma death was 7.1 %, and the cumulative incidence of other causes of death was 7.4 %. We identified that variables associated with an elevated probability of melanoma-specific mortality included older age, male sex, thick melanoma, ulcerated cancer, and positive lymph nodes. The nomograms were well calibrated. C-indexes were 0.85 and 0.83 for nomograms predicting the probability of melanoma mortality and competing risk mortality, which suggests good discriminative ability.ConclusionsThis large study cohort enabled us to build a reliable competing risk model and nomogram for predicting melanoma prognosis. Model performance proved to be good. This individualized predictive tool can be used in clinical practice to help treatment-related decision making.
Highlights
The objectives of this study were to evaluate and model the probability of melanoma-specific death and competing causes of death for patients with melanoma by competing risk analysis, and to build competing risk nomograms to provide individualized and accurate predictive tools
Additional patients were excluded for the following reasons: age, race, thickness, ulceration, site, and N stage classified as unknown; tumor thickness >9.8 mm; site coded as overlapping lesion of skin; cancer diagnosed as metastatic tumors; and being younger than 20 years old
46.0 % of melanomas occurred in the extremities, followed by 34.9, 12.0, and 7.0 % that were found in the trunk, face and ears, or scalp and neck
Summary
The objectives of this study were to evaluate and model the probability of melanoma-specific death and competing causes of death for patients with melanoma by competing risk analysis, and to build competing risk nomograms to provide individualized and accurate predictive tools. In the United States, there were an estimated 76,690 new melanoma patients in 2013, causing approximately 9480 deaths [1]. According to data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, the 5-year overall survival rate for patients with melanoma diagnosed between 2004 and 2012 was 81 %, and for those with tumor size smaller than 1 mm, which constitutes approximately 65 % of all newly diagnosed melanomas, the outcomes are excellent, with a 5-year survival rate of 89 % [3]. The majority of patients with melanoma are cured by adequate surgical excision [4]. Given this situation, many patients may survive longer and eventually die from non-cancer-related causes.
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