Abstract
BackgroundThis study aimed to assess the independent prognostic value of tumor size compared with other clinical and pathologic features of primary invasive cutaneous melanoma (CM).MethodsThis study included 28,593 patients with primary invasive CM in Surveillance, Epidemiology, and End Results Program database diagnosed from 2004 through 2016. Tumor size was divided into five subgroups (≤6, 7‐12, 13‐30, 31‐42, and >42 mm). The primary endpoint was melanoma‐specific survival (MSS).ResultsThe relationship between tumor size and survival was piecewise. After adjusting for age, sex, primary site, histopathologic cell type, Breslow thickness, ulceration, mitotic rate, regional metastasis, and distant metastasis, the hazard ratio (HR) of MSS increased with increasing tumor size until a peak at 31‐42 mm (HRs, 1.33, 1.59, 2.41, respectively; all P < .0001), and then decreased when tumor size was larger than 42 mm using tumor size ≤ 6 mm as the reference (HR, 2.11; 95% confidence interval [CI], 1.84 −2.42; P < .0001). This pattern mostly remained after stratification by T subcategories from T1 to T4 in localized primary CM except that tumor size >42 mm subgroup had the shortest MSS in T4. In addition, tumor size with a cutoff value of 12 mm showed stronger prognostic value for MSS (HR, 2.32; 95% CI, 1.80‐2.98; P < .0001) than Breslow thickness and mitotic rate in primary CM with T1N0M0.ConclusionsTumor size was an important independent prognostic factor for MSS in patients with primary invasive CM. Tumor size larger than 30 mm would provide additional and important prognostic information in each T subcategory of localized CM. Furthermore, tumor size with a cutoff value of 12 mm has great potential in improving the accuracy of melanoma T1 substaging.
Highlights
Cutaneous melanoma (CM) continues to be a significant contributor to cancer morbidity and mortality.[1,2] Current assessment of survival outcomes of cutaneous melanoma (CM) patients is based on the American Joint Committee on Cancer (AJCC) staging.[3]
After adjusting for age, sex, primary site, histopathologic cell type, Breslow thickness, ulceration, mitotic rate, regional metastasis, and distant metastasis in multivariate analysis, the hazard ratio (HR) of melanoma-specific survival (MSS) increased with increasing tumor size until a peak at 31-42 mm (HRs from 1.33 to 2.41; all P < .0001), after which increasing tumor size (>42 mm) was related to decreased HR (HR, 2.11; 95% confidence interval [CI], 1.84-2.42; P < .0001), but was still greater than that of tumor size 13-30 mm (Table 4)
We investigated whether tumor size could further stratify the patients with localized primary CM in each T category
Summary
Cutaneous melanoma (CM) continues to be a significant contributor to cancer morbidity and mortality.[1,2] Current assessment of survival outcomes of CM patients is based on the American Joint Committee on Cancer (AJCC) staging.[3]. CM patients with localized tumors typically exhibit favorable prognosis, but recent studies have shown that patients with early stage CM contribute a substantial number of deaths from melanoma.6,7 31-gene expression profile was reported to be capable to provide personalized prognostic information based on tumor biology.[8,9]. It could be time-consuming and require specific equipment. Saldanha et al[13] identified the independent prognostic value of tumor area calculated by tumor size and Breslow thickness for the 1239 cases (HR, 1.70), and it provided better stratification for MSS than Breslow thickness, which suggested that tumor size may have additional and important prognostic value for CM These studies were based on complicated histological measurements and may be laborious. We described the effects of tumor size on MSS in patients with primary invasive CM and further evaluated its prognostic effects on localized primary CM in each T subcategory
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
