Aim:
The landscape of melanoma has radically changed, with the arrival of novel melanoma treatments including targeted and immunotherapies since 2011. As such we were interested in whether these factors can still be used to predict the survival outcome of advanced melanoma.
Methods:
A retrospective analysis of The Canberra Hospital melanoma database identified 161 patients with Stage IV melanoma between 2010 and 2017. Ocular melanoma was excluded. Patients were required to have at least 12 months follow-up. Prognostic factors included gender, age, American Joint Committee on Cancer (AJCC) Staging 8th edition, number of metastatic sites, serum LDH, neutrophil-lymphocyte ratio (NLR) and eastern cooperative oncology group (ECOG) performance status at the time of diagnosis. Survival was analysed by demographics and clinical factors with chi-square tests to determine significance. Logistic binary regression was performed to test the independence of the clinical factors on predicting the survival outcome.
Results:
Overall, the 3-month, 6-month, 9-month, and 12-month stage IV melanoma survival rate of our cohort was 79%, 67%, 55%, and 45%, respectively. Age, sex and BRAF mutation status were found to have no impact on survival, whereas M1d category of AJCC staging (8th edition), NLR>3, elevated LDH, > 3 metastatic sites, brain metastases, poorer ECOG status were associated with poorer survival. Binary logistic regression test identified AJCC staging, NLR (cutoff score 3), LDH, and brain metastases as independent prognostic factors.
Conclusion:
Most clinical factors investigated in this study were found to have statistically significant impact on survival, with AJCC (8th), NLR (cutoff score 3), LDH, and brain metastases identified as independent prognostic factors in stage IV melanoma from a contemporary cohort treated with targeted therapies and immunotherapies.