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Originally published as JCO Early Release 10.1200/JCO.2008.20.5666 on January 21 2009 © 2009 American Society of Clinical Oncology.
Different Natural Course of Disease in Patients With MelanomaInstitute of Oncology Ljubljana, Ljubljana, Slovenia To the Editor: We read with great interest the article by Lee et al1 in Journal of Clinical Oncology. By multivariate analysis of 1,571 patients, the authors identified five independent prognostic factors: age, sex, nodal tumor burden, decade of diagnosis, and status of primary tumor. Whereas age, sex, nodal tumor burden, and status of primary tumor are well-known significant prognostic factors, this is not the case with decade of diagnosis. Lee at al stated that the significance of decade of diagnosis was a reflection of the poorer survival of patients treated in the 1980s. We agree that patients with melanoma with regional nodal metastases had poorer survival in the 1980s, compared with that of patients with the same stage of disease from 1990 to 2000. Lasithiotakis et al2 studied a cohort of 4,791 patients diagnosed with primary cutaneous melanoma (CM) in southern Germany between 1976 and 2001, and reported that improvement of survival among CM patients diagnosed between 1990 and 2001, compared with those diagnosed between 1976 and 1989, may not have been entirely attributable to factors associated with early diagnosis and more favorable primary tumors. Our group studied the entire Slovenian population of patients with melanoma using the Slovenian National Cancer Registry, and found that the most important independent predictor of survival among patients diagnosed with CM between 1983 and 1997 was time of diagnosis.3 Because treatment of patients with melanoma with regional metastases has unfortunately not changed in the last three decades, we believe that the disease itself has become less aggressive. Moreover, less aggressive disease—and the subsequent lower number of events (regional and systemic metastases)—is probably the reason why the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) was underpowered, and did not show OS benefit in patients with nodal micrometastases and immediate lymphadenectomy compared with those with delayed lymphadenectomy.4 Calculations of the sample size were based on the survival data of patients with melanoma treated before the 1990s. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES
1. Lee CC, Faries MB, Wanek LA, et al: Improved survival after lymphadenectomy for nodal metastasis from an unknown primary melanoma. J Clin Oncol 26:535–541, 2008. 2. Lasithiotakis KG, Leiter U, Eigentler T, et al: Improvement of overall survival of patients with cutaneous melanoma in Germany, 1976-2001: Which factors contributed? Cancer 109:1174–1182, 2007.[CrossRef][Medline] 3. Peric B, Zgajnar J, Besic N, et al: Changing biology of cutaneous melanoma. Melanoma Res 18:225–229, 2008.[CrossRef][Medline] 4. Morton DL, Thompson JF, Cochran AJ, et al: Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 355:1307–1317, 2006.
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Copyright © 2009 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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