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The kinetics of the visible growth of a primary melanoma reflects the tumor aggressiveness and is an independent prognostic marker: A prospective study
Author(s) -
Grob Jean Jacques,
Richard Marie Aleth,
Gouvernet Johany,
Avril Marie Françoise,
Delaunay Michèle,
Wolkenstein Pierre,
Souteyrand Pierre,
Bonerandi Jean Jacques,
Machet Laurent,
Guillaume Jean Claude,
ChevrantBreton Jacqueline,
Vilmer Catherine,
Aubin François,
Guillot Bernard,
BeylotBarry Marie,
Lok Catherine,
RaisonPeyron Nadia,
Chemaly Philippe
Publication year - 2002
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.10660
Subject(s) - medicine , surrogate endpoint , oncology , prospective cohort study , multivariate analysis , melanoma , univariate , proportional hazards model , prognostic variable , univariate analysis , multivariate statistics , cancer research , statistics , mathematics
Primary melanoma (MM) could be a good model to test an intuitive concept: a cancer that is growing fast in its early phase is likely to have a high aggressiveness. Since MMs are visible tumors, many patients can provide information to indirectly assess the kinetics of their lesion. A prospective study was designed to assess if the kinetics of the visible growth of a primary MM, as described by the patient, could be a noninvasive prognostic marker. The ratio of MM thickness to delay between MM appearance and MM removal was used as a surrogate value for the kinetics of the MM growth. To assess the delay between MM appearance and removal, 362 patients with self‐detected invasive MM fulfilled a detailed questionnaire, which provided 2 types of estimations of this delay and thus 2 melanoma kinetics indexes (MKI and MKI*). After a median follow‐up of 4 years, univariate and multivariate analyses assessed whether relapse‐free survival was linked to MKI or MKI*. MKI was significantly predictive of relapse‐free survival (HR = 1.84 [1.51–2.25]) and relapse at 1 year (RR = 2.93 [1.84–4.69]), independently from Breslow thickness. MKI was retained in multivariate prognostic models, just after thickness and before other usual markers. MKI* was also a significant independent risk marker, although less predictive. In this model, the initial growth kinetics of a cancer reflects its aggressiveness and a high index predicts a short‐term relapse. The “subjective” data obtained from patients about their MM history, although usually neglected, can thus provide a better prognostic marker than many “objective” tests. © 2002 Wiley‐Liss, Inc.