ELEVATED PRETREATMENT SERUM LEVELS OF SOLUBLE VASCULAR CELL-ADHESION MOLECULE-1 AND LACTATE-DEHYDROGENASE AS PREDICTORS OF SURVIVAL IN CUTANEOUS METASTATIC MALIGNANT-MELANOMA

Very rapid progression of disease with a median survival of 6-9 months is a common feature of metastatic cutaneous malignant melanoma. Never theless, substantial variability of survival suggests that metastatic cutaneous malignant melanoma can be divided into several biological su bgroups. Pretreatment serum levels of soluble adhesion molecules and v arious clinical parameters in cutaneous metastatic malignant melanoma were evaluated to determine their prognostic value. In this study pret reatment serum levels of soluble vascular cell adhesion molecule 1 (sV CAM-1), soluble intercellular cell adhesion molecule 1 (sICAM-1), solu ble endothelial leukocyte adhesion molecule 1 (sE-selectin) and multip le clinical factors were assessed in relation to overall survival of 9 7 consecutive patients with metastatic cutaneous malignant melanoma se en at our institution between May 1990 and April 1996, For statistical analysis, both univariate and multivariate Cox proportional-hazards m odels were used. Elevated pretreatment serum levels of sVCAM-1 (P < 0. 005) and of lactate dehydrogenase (P < 0.002) were rendered statistica lly independent and were significantly associated with unfavourable ou tcome. Patients were assigned to one of three risk categories (low, in termediate and high) according to a cumulative risk score defined as t he function of the sum of these two variables. There were significant differences in overall survival (P < 0.0001) between low- (n = 53, 5-y ear survival probability of 23.3%), intermediate- (n = 29, 5-year surv ival probability of 9.9%) and high-risk (n = 15) patients. Elevated pr etreatment serum levels of sVCAM-1 and of lactate dehydrogenase correl ate with poor outcome in metastatic cutaneous malignant melanoma. Thes e data support risk stratification for future therapeutic trials and i dentify factors that need to be validated in prospective studies and m ay potentially influence decision-making in palliative management of p atients with disseminated cutaneous malignant melanoma.