Survival Nomogram for Stage IV (M1a-c) Melanoma: A Population-Based Study Highlighting the Prognostic Correlates of Surgery in Pre-Immunotherapy and Early Immunotherapy Eras.
Metastatic melanoma has a poor prognosis. This study aimed to develop and validate era-specific nomograms for Stage IV (M1a-c) melanoma and assess the survival impact of surgery across two eras.
This retrospective Surveillance, Epidemiology, and End Results (SEER) study included 3,319 stage IV melanoma patients divided into pre-immunotherapy era (2001-2005, n = 622) and early immunotherapy era (2011-2015, n = 2,697) cohorts. Cox regression identified overall survival (OS) prognostic factors. Era-specific nomograms predicting 1-, 3-, and 5-year OS were constructed and validated. The survival benefit of surgery was assessed using Kaplan-Meier analysis.
Age, M-stage, lactate dehydrogenase, chemotherapy, and surgery were consistent independent prognostic factors in both eras. The nomograms showed good calibration yet limited discriminatory capacity only slightly exceeding the 0.5 random threshold (C-index: 0.649 and 0.641 for pre- and early immunotherapy eras, respectively). Surgery showed longer OS in patients of the overall immunotherapy cohort: median OS was 17 vs. 6 months for surgical vs. non-surgical patients (p < 0.001). The benefit was pronounced in the M1a (40.5 vs. 20.0 months, p < 0.001) and M1c (11 vs. 5 months, p < 0.001) subgroups. Patients in the early immunotherapy era had longer OS (8 vs. 6 months, p < 0.001).
We constructed population-based era-specific nomograms for stage IV melanoma. Within the immunotherapy cohort, surgery correlates with prolonged survival, suggesting surgical evaluation for selected metastatic melanoma patients.
This retrospective Surveillance, Epidemiology, and End Results (SEER) study included 3,319 stage IV melanoma patients divided into pre-immunotherapy era (2001-2005, n = 622) and early immunotherapy era (2011-2015, n = 2,697) cohorts. Cox regression identified overall survival (OS) prognostic factors. Era-specific nomograms predicting 1-, 3-, and 5-year OS were constructed and validated. The survival benefit of surgery was assessed using Kaplan-Meier analysis.
Age, M-stage, lactate dehydrogenase, chemotherapy, and surgery were consistent independent prognostic factors in both eras. The nomograms showed good calibration yet limited discriminatory capacity only slightly exceeding the 0.5 random threshold (C-index: 0.649 and 0.641 for pre- and early immunotherapy eras, respectively). Surgery showed longer OS in patients of the overall immunotherapy cohort: median OS was 17 vs. 6 months for surgical vs. non-surgical patients (p < 0.001). The benefit was pronounced in the M1a (40.5 vs. 20.0 months, p < 0.001) and M1c (11 vs. 5 months, p < 0.001) subgroups. Patients in the early immunotherapy era had longer OS (8 vs. 6 months, p < 0.001).
We constructed population-based era-specific nomograms for stage IV melanoma. Within the immunotherapy cohort, surgery correlates with prolonged survival, suggesting surgical evaluation for selected metastatic melanoma patients.