Conditional Survival After Initial Diagnosis and Treatment of Stage III Melanoma

Key Points

  • Conditional melanoma-specific survival was similar to that in patients with stage IIIA melanoma for patients with stage IIIB melanoma after 3 years and for patients with stage IIIC melanoma after 5 years.
  • Conditional survival was worse with increasing age at every time point and for men vs women at 1 and 2 years but not thereafter.

In an Australian study reported in the Journal of Clinical Oncology, Haydu et al found that conditional melanoma-specific survival was worse within the first 2 years of diagnosis of stage III disease for men, increasing age, and increasing American Joint Committee on Cancer (AJCC) stage. The findings suggest that adjuvant systemic treatments may have the greatest benefit when administered within this period.

Study Details

The study involved derivation of conditional survival estimates from 4,540 patients diagnosed with stage III melanoma and treated at the Melanoma Institute Australia. Conditional 5-year melanoma-specific survival estimates up to 5 years after diagnosis were adjusted for age, sex, and 8th edition AJCC stage.

Conditional Melanoma-Specific Survival by Stage

Conditional melanoma-specific survival estimates increased with each year of survival in all stages at diagnosis. For patients with AJCC stage IIIB and IIIC disease, melanoma-specific survival outcomes were similar to those of patients with stage IIIA disease after 3 and 5 years of survival, respectively. By stage, 5-year melanoma-specific survival estimates adjusted for sex and age at stage III diagnosis at baseline and at 1, 2, 3, 4, and 5 years were 81.4%, 79.5%, 82.3%, 83.1%, 86.0%, and 88.7% for stage IIIA; 64.0%, 64.9%, 71.2%, 76.0%, 79.7%, and 82.7% for stage IIIB; 44.5%, 48.1%, 58.0%, 66.7%, 73.1%, and 78.8% for stage IIIC; and 9.8%, 17.2%, 25.6%, 40.6%, 35.8%, and 55.4% for stage IIID.

Effect of Stage, Age, and Sex

With stage IIIA as the reference category, conditional melanoma-specific survival was significantly worse for stages IIIB, IIIC, and IIID disease at 1 year (hazard ratios [HRs] = 1.9–7.6) and 2 years (HRs = 1.8–6.9), stages IIIC and IIID disease at 3 years (HRs = 2.2 and 4.8) and 4 years (HRs = 2.1 and 6.9), and stage IIID disease at 5 years (HR = 5.2). Increasing age was associated with a significantly worse conditional melanoma-specific survival at all yearly time points (HRs = 1.010–1.017 for each 1 year increase in age). Men had significantly worse conditional survival vs women at 1 and 2 years (HR = 1.2 for each) but not at 3, 4, or 5 years.

The investigators concluded: “Adjuvant systemic treatments may have the greatest benefit when administered within the first 2 years of stage III melanoma diagnosis, during which period prognosis is significantly worse for male patients of increasing age and AJCC stage. Conditional survival estimates illustrate improved survival prospects for patients with cancer returning for follow-up and may define a finite period of increased risk after diagnosis.”

John F. Thompson, MD, of the Melanoma Institute Australia, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.