Site and timing of first relapse in stage III melanoma patients: Implications for follow-up guidelines Journal Article


Authors: Romano, E.; Scordo, M.; Dusza, S.; Coit, D. G.; Chapman, P. B.
Article Title: Site and timing of first relapse in stage III melanoma patients: Implications for follow-up guidelines
Abstract: Purpose: Stage III melanoma is associated with a high risk of relapse and mortality. Nevertheless, follow-up guidelines have largely been empirical rather than evidence-based. Patients and Methods: Clinical records of stage III patients with no evidence of disease seen at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1992 and 2004, who ultimately relapsed, were reviewed retrospectively to evaluate date of first relapse, time to first relapse, method of first relapse detection, and survival. We also determined overall 5-year relapse-free survival (RFS) of all stage III patients seen at MSKCC during this period. Results: The overall 5-year RFS for stage IIIA, IIIB, and IIIIC patients was 63%, 32%, and 11%, respectively. Among relapsing patients, 340 had adequate follow-up to be evaluable for all parameters. Site of first relapse was local/in-transit (28%), regional nodal (21%), or systemic (51%). First relapses were detected by the patient or family, physician, or by screening radiologic tests in 47%, 21%, and 32% of patients, respectively. Multivariate analysis revealed that better overall survival was associated with younger age and first relapse being local/in-transit or nodal, asymptomatic, or resectable. For each substage, we estimated site-specific risk of first relapse. Conclusion: Patients detected almost half of first relapses. Our data suggest that routine physical examinations beyond 3 years for stage IIIA, 2 years for stage IIIB, and 1 year for stage IIIC patients and radiologic imaging beyond 3 years for stages IIIA and IIIB and 2 years for stage IIIC patients would be expected to detect few first systemic relapses. © 2010 by American Society of Clinical Oncology.
Keywords: adolescent; adult; cancer survival; child; school child; aged; aged, 80 and over; middle aged; survival rate; retrospective studies; young adult; major clinical study; mortality; cancer localization; cancer recurrence; cancer risk; cancer staging; follow up; follow-up studies; cancer diagnosis; neoplasm staging; melanoma; cohort studies; neoplasm recurrence, local; cohort analysis; practice guideline; pathology; retrospective study; time; time factors; risk assessment; radiology; tumor recurrence; practice guidelines as topic; cancer relapse
Journal Title: Journal of Clinical Oncology
Volume: 28
Issue: 18
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2010-06-20
Start Page: 3042
End Page: 3047
Language: English
DOI: 10.1200/jco.2009.26.2063
PUBMED: 20479405
PROVIDER: scopus
PMCID: PMC3664035
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Stephen Dusza
    162 Dusza
  2. Paul Chapman
    246 Chapman
  3. Daniel Coit
    415 Coit
  4. Emanuela Romano
    11 Romano
  5. Michael Scordo
    33 Scordo