PROLONGED SURVIVAL OF 2 YEARS OR LONGER FOR PATIENTS WITH DISSEMINATED MELANOMA - AN ANALYSIS OF RELATED PROGNOSTIC FACTORS

BACKGROUND. Once melanoma has metastasized to distant sites, the progn osis is usually poor, showing an overall median survival of 6-8 months . Long term survival is extremely rare, and there is still controversy concerning the prognostic significance of therapeutic modalities. The aim of the current study was to identify important prognostic factors associated with Stage IV melanoma. METHODS, The current study was bas ed on data for 3258 melanoma patients, for whom clinical, pathologic, and long term follow-up information was recorded during the period 197 6-1996 at the Eberhard-Karls-University in Tuebingen, Germany. The att ainment of 2 years' or longer survival time by patients with dissemina ted melanoma was addressed, and a multivariate analysis of related pro gnostic factors was performed by logistic regression. RESULTS, Four hu ndred forty-two patients (13.6%) developed distant metastasis. The med ian survival time was 7 months, and the 2-year, 5-year, and 10-year su rvival rates were 11.9%, 6.7%, and 4.7%, respectively. Forty-five pati ents had prolonged survival of 2 years or longer. Significantly more f emales belonged to the group of long term survivors (P = 0.0186). Of t he modalities of therapy given, only surgery was associated with prolo nged survival (P < 0.0001). Primary metastasis to the skin (P = 0.006) , the brain (P = 0.015), more than a single metastatic site (P = 0.002 ), and Karnofsky performance status of less than 80 (P = 0.0035) were significantly related to short term survival. In addition, subsequent development of two Or more new metastatic sites was also associated wi th short term survival (P = 0.0025). CONCLUSIONS. In the current analy sis, prolonged survival of 2 years or longer for patients with dissemi nated melanoma was shown to depend on gender, site of primary metastas is, number of metastatic sites, and Karnofsky performance status. Of t he modalities of therapy given, only surgery significantly influenced survival. However, in a small percentage of patients, long term comple te remission was achieved with chemotherapy alone or in combination wi th surgery, suggesting that such regimens might be curative in selecte d cases. (C) 1997 American Cancer Society.