Prognostic factors in metastatic melanoma: A pooled analysis of Eastern Cooperative Oncology Group trials

Purpose: To identify factors that are prognostic for survival in patients w ith metastatic melanoma treated in eight Eastern Cooperative Oncology Group (ECOG) trials conducted over the past 25 years. Methods: We identified common, significant patient characteristics collecte d at baseline on 1,362 eligible patients for inclusion in a pooled analysis . Proportional hazards models were used to examine simultaneously the effec ts of multiple covariates on survival. Results: Median survival wets 6.4 months (95% confidence interval, 6,1 to 6 .9 months.) Factors conferring the greatest increased risk of death include d number of metastatic sites (relative risk [RR] = 1,12), ECOG performance status of 1 or more (RR = 1.49), or metastatic disease in the gastrointesti nal (GI) tract (RR = 1.49), liver (RR = 1,44), pleura (RR = 1.35)1 or lung (RR = 1.19). Prior immunotherapy (RR = 0.84) and female sex (RR = 0.87) wer e associated with prolonged survival. Although only 12% of patients respond ed to protocol treatment, landmark analysis showed this to be a significant prognostic factor (RR = 0,57), A model based on three recent studies in wh ich baseline values for alka- line phosphatase, lactate dehydrogenase (LDH) , and platelets were available identified an increased number of sites of m etastasis (RR = 1.30), abnormal LDH (RR = 1.89), abnormal alkaline phosphat ase (RR = 1,76), abnormal platelets (RR = 1.63), and GI metastases ( = 1,66 ) as prognostic for poorer survival. Response to treatment, when examined b y landmark analysis of studies with laboratory parameters, wets associated with decreased risk of death (RR = 0,47). Conclusion: This study demonstrates the importance and utility of laborator y parameters as prognostic factors for survival and confirmed the deleterio us effects of multiple metastatic sites, Prior immunotherapy and female sex were associated with improved prognosis. Prognostic factors identified in this analysis are consistent with the findings of prior published studies a nd argue for the adoption of laboratory findings in the staging systems tha t are used for entry and stratification of clinical trials in the future. ( C) 2000 by American Society of Clinical Oncology.