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Relationship Between Disease-Free Interval and Survival in Patients With Recurrent Melanoma

Relationship Between Disease-Free Interval and Survival in Patients With Recurrent Melanoma Abstract • A total of 2468 patients with recurrent melanoma were subdivided on the basis of disease-free interval: group 1 had recurrences within 1 year (n=810), group 2 at years 1 to 3 (n=1001), group 3 at years 3 to 5 (n=363), group 4 at years 5 to 10 (n=329), and group 5 after 10 years (n=145). Ten-year survivals were 21%, 23%, 25%, 28%, and 35%, respectively. Patients who had recurrences within 1 year had a decreased median survival compared with those who had later recurrences, although the differences were not clinically significant (only 6 to 8 months). Survival was improved for the few patients who had recurrences longer than 10 years from diagnosis. However, for the majority of patients, who had recurrences between 1 and 10 years, the disease-free interval did not predict subsequent survival. The data support the hypothesis that malignant cells can exist in a state of relative quiescence for extended periods. Once disease reactivation occurs, however, the subsequent survival is relatively predictable and is independent of the initial period of tumor dormancy. (Arch Surg. 1992;127:1303-1308) References 1. Balch CM, Soong S, Shaw HM, Milton GW. An analysis of prognostic factors in 4000 patients with cutaneous melanoma . In: Balch CM, Milton GW, Shaw HM, Soong S, eds. Cutaneous Melanoma: Clinical Management and Treatment Results Worldwide . Philadelphia, Pa: JB Lippincott Co; 1985: 321-352. 2. Drzewiecki KT, Frydman H, Andersen PK, Poulsen H, Ladefoged C, Vibe P. Malignant melanoma: changing trends in factors influencing metastasis-free survival from 1964 to 1982 . Cancer . 1990;65:362-366.Crossref 3. Balch CM, Soong S, Murad TM, Ingalls AL, Maddox WA. A multifactorial analysis of melanoma: prognostic factors in patients with stage I (localized) melanoma . Surgery . 1979;86:343-351. 4. Balch CM, Soong S, Murad TM, Ingalls AL, Maddox WA. A multifactorial analysis of melanoma: prognostic factors in melanoma patients with lymph node metastases (stage II) . Ann Surg . 1981;193:377-388.Crossref 5. Yarnold JR, Cochrane JPS. Malignant melanoma: significance of disease free interval . Br J Radiol . 1980;53:1068-1070.Crossref 6. Rajpal S, Moore R, Karakousis CP. Survival in metastatic ocular melanoma . Cancer . 1983;52:334-336.Crossref 7. Balch CM, Soong S, Murad TM, Smith J, Maddox WA, Duirant JR. A multifactorial analysis of melanoma: prognostic factors in 200 melanoma patients with distant metastases (stage III) . J Clin Oncol . 1983;1:126-134. 8. Nambisan RN, Alexiou G, Reese PA, Karakousis CP. Early metastatic patterns and survival in malignant melanoma . J Surg Oncol . 1987;34:248-252.Crossref 9. Amer MH, Al-Sarraf M, Vaitkevicius VK. Clinical presentation, natural history and prognostic factors in advanced malignant melanome . Surg Gynecol Obstet . 1979;149:687-692. 10. Reintgen DS, Vollmer R, Tso CY, Seigler HF. Prognosis for recurrent stage I malignant melanoma . Arch Surg . 1987;122:1338-1342.Crossref 11. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Crossref 12. Cox DR. Regression model and life tables . ] R Stat Soc Br . 1972;42: 187-220. 13. Greene MH, Young TI, Clerke WH. Malignant melanoma in renal transplant recipients . Lancet . 1981;1:1196-1198.Crossref 14. Gupta AK, Cardella CJ, Haberman HF. Cutaneous malignant neoplasms in patients with renal transplants . Arch Dermatol . 1986;122:1288-1293.Crossref 15. Penn I. Tumors of the immunocompromised patient . Ann Rev Med . 1988;39:63-73.Crossref 16. Ioachim HL. The opportunistic tumors of immune deficiency . Adv Cancer Res . 1990;54:301-317. 17. Starzl TE, Nalesnik MA, Porter KA, et al. Reversibility of lymphomas and lympho-proliferative lesions developing under cyclosporin-steroid therapy . Lancet . 1984;1:583-587.Crossref 18. McGovern VJ. Spontaneous regression of melanoma . Pathology . 1975;7:91-99.Crossref 19. Wheelock EF, Robinson MK. Biology of disease: endogenous control of the neoplastic process . Lab Invest . 1983;48:120-139. 20. Eccles SA, Alexander P. Immunologically-mediated restraint of latent tumour metastases . Nature . 1975;257:52-53.Crossref 21. Wheelock EF, Robinson MK, Truitt GA. Establishment and control of the L5178Y-cell dormant state in DBA/2 mice . Cancer Metastasis Rev . 1982; 1:29-44.Crossref 22. Liu C, Suzuki Y, Chen L, et al. Maintenance and cure of the L5178Y murine tumor-dormant state by interleukin-2: in vivo and in vitro effects . Cancer Res . 1990;50:181-188. 23. Meltzer A. Dormancy and breast cancer . J Surg Oncol . 1990;43:181-188.Crossref 24. Crowley NJ, Seigler HF. Late recurrence of malignant melanoma: analysis of 168 patients . Ann Surg . 1990;212:173-177.Crossref 25. Stewart TH, Hollonshead AC, Ramam S. Tumour dormancy: initiation, maintenance and termination in animals and humans . Can J Surg . 1991;34: 321-325. 26. Wallack MK, Bash J, Bartolucci A. Improvement in disease-free survival of melanoma patients in conjunction with serologic response in a phase Ia/Ib Southeastern Cancer Study Group Trial of vaccinia melanoma oncolysate . Am Surg . 1989;55:243-247. 27. Mitchell MS, Harel W, Kempf RA, et al. Active-specific immunotherapy of melanoma . J Clin Oncol . 1990;8:856-869. 28. Crowley NJ, Vervaert CE, Seigler HF. Human xenograft-nude mouse model of adoptive immunotherapy with human melanoma-specific cytotoxic T-cells . Cancer Res . 1992;52:394-399. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Relationship Between Disease-Free Interval and Survival in Patients With Recurrent Melanoma

Archives of Surgery , Volume 127 (11) – Nov 1, 1992

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1992.01420110045011
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Abstract

Abstract • A total of 2468 patients with recurrent melanoma were subdivided on the basis of disease-free interval: group 1 had recurrences within 1 year (n=810), group 2 at years 1 to 3 (n=1001), group 3 at years 3 to 5 (n=363), group 4 at years 5 to 10 (n=329), and group 5 after 10 years (n=145). Ten-year survivals were 21%, 23%, 25%, 28%, and 35%, respectively. Patients who had recurrences within 1 year had a decreased median survival compared with those who had later recurrences, although the differences were not clinically significant (only 6 to 8 months). Survival was improved for the few patients who had recurrences longer than 10 years from diagnosis. However, for the majority of patients, who had recurrences between 1 and 10 years, the disease-free interval did not predict subsequent survival. The data support the hypothesis that malignant cells can exist in a state of relative quiescence for extended periods. Once disease reactivation occurs, however, the subsequent survival is relatively predictable and is independent of the initial period of tumor dormancy. (Arch Surg. 1992;127:1303-1308) References 1. Balch CM, Soong S, Shaw HM, Milton GW. An analysis of prognostic factors in 4000 patients with cutaneous melanoma . In: Balch CM, Milton GW, Shaw HM, Soong S, eds. Cutaneous Melanoma: Clinical Management and Treatment Results Worldwide . Philadelphia, Pa: JB Lippincott Co; 1985: 321-352. 2. Drzewiecki KT, Frydman H, Andersen PK, Poulsen H, Ladefoged C, Vibe P. Malignant melanoma: changing trends in factors influencing metastasis-free survival from 1964 to 1982 . Cancer . 1990;65:362-366.Crossref 3. Balch CM, Soong S, Murad TM, Ingalls AL, Maddox WA. A multifactorial analysis of melanoma: prognostic factors in patients with stage I (localized) melanoma . Surgery . 1979;86:343-351. 4. Balch CM, Soong S, Murad TM, Ingalls AL, Maddox WA. A multifactorial analysis of melanoma: prognostic factors in melanoma patients with lymph node metastases (stage II) . Ann Surg . 1981;193:377-388.Crossref 5. Yarnold JR, Cochrane JPS. Malignant melanoma: significance of disease free interval . Br J Radiol . 1980;53:1068-1070.Crossref 6. Rajpal S, Moore R, Karakousis CP. Survival in metastatic ocular melanoma . Cancer . 1983;52:334-336.Crossref 7. Balch CM, Soong S, Murad TM, Smith J, Maddox WA, Duirant JR. A multifactorial analysis of melanoma: prognostic factors in 200 melanoma patients with distant metastases (stage III) . J Clin Oncol . 1983;1:126-134. 8. Nambisan RN, Alexiou G, Reese PA, Karakousis CP. Early metastatic patterns and survival in malignant melanoma . J Surg Oncol . 1987;34:248-252.Crossref 9. Amer MH, Al-Sarraf M, Vaitkevicius VK. Clinical presentation, natural history and prognostic factors in advanced malignant melanome . Surg Gynecol Obstet . 1979;149:687-692. 10. Reintgen DS, Vollmer R, Tso CY, Seigler HF. Prognosis for recurrent stage I malignant melanoma . Arch Surg . 1987;122:1338-1342.Crossref 11. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Crossref 12. Cox DR. Regression model and life tables . ] R Stat Soc Br . 1972;42: 187-220. 13. Greene MH, Young TI, Clerke WH. Malignant melanoma in renal transplant recipients . Lancet . 1981;1:1196-1198.Crossref 14. Gupta AK, Cardella CJ, Haberman HF. Cutaneous malignant neoplasms in patients with renal transplants . Arch Dermatol . 1986;122:1288-1293.Crossref 15. Penn I. Tumors of the immunocompromised patient . Ann Rev Med . 1988;39:63-73.Crossref 16. Ioachim HL. The opportunistic tumors of immune deficiency . Adv Cancer Res . 1990;54:301-317. 17. Starzl TE, Nalesnik MA, Porter KA, et al. Reversibility of lymphomas and lympho-proliferative lesions developing under cyclosporin-steroid therapy . Lancet . 1984;1:583-587.Crossref 18. McGovern VJ. Spontaneous regression of melanoma . Pathology . 1975;7:91-99.Crossref 19. Wheelock EF, Robinson MK. Biology of disease: endogenous control of the neoplastic process . Lab Invest . 1983;48:120-139. 20. Eccles SA, Alexander P. Immunologically-mediated restraint of latent tumour metastases . Nature . 1975;257:52-53.Crossref 21. Wheelock EF, Robinson MK, Truitt GA. Establishment and control of the L5178Y-cell dormant state in DBA/2 mice . Cancer Metastasis Rev . 1982; 1:29-44.Crossref 22. Liu C, Suzuki Y, Chen L, et al. Maintenance and cure of the L5178Y murine tumor-dormant state by interleukin-2: in vivo and in vitro effects . Cancer Res . 1990;50:181-188. 23. Meltzer A. Dormancy and breast cancer . J Surg Oncol . 1990;43:181-188.Crossref 24. Crowley NJ, Seigler HF. Late recurrence of malignant melanoma: analysis of 168 patients . Ann Surg . 1990;212:173-177.Crossref 25. Stewart TH, Hollonshead AC, Ramam S. Tumour dormancy: initiation, maintenance and termination in animals and humans . Can J Surg . 1991;34: 321-325. 26. Wallack MK, Bash J, Bartolucci A. Improvement in disease-free survival of melanoma patients in conjunction with serologic response in a phase Ia/Ib Southeastern Cancer Study Group Trial of vaccinia melanoma oncolysate . Am Surg . 1989;55:243-247. 27. Mitchell MS, Harel W, Kempf RA, et al. Active-specific immunotherapy of melanoma . J Clin Oncol . 1990;8:856-869. 28. Crowley NJ, Vervaert CE, Seigler HF. Human xenograft-nude mouse model of adoptive immunotherapy with human melanoma-specific cytotoxic T-cells . Cancer Res . 1992;52:394-399.

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1992

References