Rt. Vollmer et Hf. Seigler, Using a continuous transformation of the Breslow thickness for prognosis in cutaneous melanoma, AM J CLIN P, 115(2), 2001, pp. 205-212
Citations number
67
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology","Medical Research Diagnosis & Treatment
Although the Breslow thickness provides the most important histologic infor
mation for prognosis in cutaneous melanoma, controversies and uncertainty r
emain about how best to use thickness. It is unclear whether cutpoints shou
ld be used, or if they are used, which are optimal. We studied new data col
lected from more than 1, 000 patients followed up for a relatively long per
iod. From Cox proportional hazards models of survival we learned that more
cut points provide more prognostic information than using, for example, jus
t I cutpoint at 1.7 mm. Nevertheless, a continuous transformation provides
an effective alternative that captures the information that thickness provi
des, and it avoids the pitfalls of using multiple cutpoints. In a multivari
ate model, this transformation provided strong prognostic information, and
the result produced a prognostic score for cutaneous melanoma. This score p
rovides a practical way that Cox model results can be used, and we believe
it consolidates the prognostic information provided by traditional histolog
ic and clinical variables. When newer prognostic variables are introduced,
we suggest that they be used with this continuous transformation of thickne
ss rather than with cutpoints in thickness.