PROGNOSTIC FACTORS FOR SURVIVAL OF PATIENTS TREATED SYSTEMICALLY FOR DISSEMINATED MELANOMA

Purpose: The current American Joint Commission on Cancer (AJCC) stagin g system distinguishes between soft tissue and visceral metastases in advanced (stage IV) melanoma, We sought to verify these staging criter ia and to identify prognostic variables that could be used to evaluate the impact of systemic therapy on long-term survival during the prior decade. Patients and Methods: We conducted a retrospective study of p atients with advanced cutaneous melanoma enrolled in clinical trials b etween 1979 and 1989 at The University of Texas M.D. Anderson Cancer C enter. Pretreatment age, sex, number of organs with metastases, serum levels of lactate dehydrogenase (LDH) and albumin, and period of enrol lment were analyzed using a Cox proportional hazards model of survival . Results: In univariate and multivariate analyses that involved 318 s tage IV patients, normal serum levels of LDH and albumin, soft tissue and/or single visceral organ metastases (especially lung), female sex, and enrollment late in the decade were independent positive predictor s for survival. In multivariate analyses, the current AJCC criteria di d not significantly predict outcome. Systemic treatment response did n ot bias these results, and only 4% of patients had a complete response . Patients who lived more than 2 years (11%) had a mix of favorable pr ognostic characteristics and a high frequency of systemic or surgicall y induced complete response. Conclusion: This study supports the use o f stratification parameters that reflect the favorable prognostic impa ct of soft tissue or single visceral organ metastases and normal serum levels of LDH and albumin at time of enrollment in advanced melanoma trials. Improved survival over the prior decade probably reflects adva nces in diagnostic and palliative interventions. (C) 1998 by American Society of Clinical Oncology.