title: Prognostic value of circulating melanoma cells detected by reverse transcriptase-polymerase chain reaction.
abstract: OBJECTIVE
  Factors that are predictive of prognosis in patients who are diagnosed with malignant melanoma (MM) are widely awaited. Detection of circulating melanoma cells (CMCs) by reverse transcriptase-polymerase chain reaction (RT-PCR) has recently been postulated as a possible negative prognostic factor. Two main questions were addressed: first, whether the presence of CMCs, defined as the patient being positive for any of the three markers, had a prognostic role; and second, what the predictive value of each individual marker was.
  
  
  METHODS
  A consecutive series of 200 melanoma patients observed between January 1997 and December 1997, with stage of disease ranging from I to IV, was analyzed by semiquantitative RT-PCR. Tyrosinase, p97, and MelanA/MART1 were used as markers to CMCs on baseline peripheral blood samples. Progression-free survival (PFS) was used as a unique end point and was described by the product limit method. Multivariable analysis was applied to verify whether the auspicated prognostic value of these markers was independent of the stage of disease, and a subgroup analysis was performed that excluded patients with stage IV disease.
  
  
  RESULTS
  Overall, 32% (64 of 200) of patients progressed, and a median PFS of 52 months in the whole series was observed. The presence of CMCs and the markers individually or combined was predictive of prognosis in the univariate analysis but did not provide additional prognostic information to the stage of disease in multivariable models. In the subgroup analysis of stage (ie, I-III subgroup), similar results were observed.
  
  
  CONCLUSIONS
  Detection of CMCs in peripheral blood samples at the time of MM diagnosis by semiquantitative RT-PCR does not add any significant predictive value to the stage of disease. Thus, this approach should not be used in clinical practice, and further studies are required to determine its usefulness.
authors.affiliation: Institute of Genetics of Populations, Consiglio Nazionale delle Ricerche, Alghero (Sassari), Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Palmieri
authors.forename: Paolo A
authors.initials: PA
authors.lastname: Ascierto
authors.forename: Francesco
authors.initials: F
authors.lastname: Perrone
authors.forename: Sabrina M R
authors.initials: SM
authors.lastname: Satriano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ottaiano
authors.forename: Antonio
authors.initials: A
authors.lastname: Daponte
authors.forename: Maria
authors.initials: M
authors.lastname: Napolitano
authors.forename: Corrado
authors.initials: C
authors.lastname: Caracò
authors.forename: Nicola
authors.initials: N
authors.lastname: Mozzillo
authors.forename: Maria T
authors.initials: MT
authors.lastname: Melucci
authors.forename: Antonio
authors.initials: A
authors.lastname: Cossu
authors.forename: Francesco
authors.initials: F
authors.lastname: Tanda
authors.forename: Ciro
authors.initials: C
authors.lastname: Gallo
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Satriano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Castello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D058965:MART-1 Antigen; D008297:Male; D008545:Melanoma / Q000097:blood* / Q000175:diagnosis; D058950:Melanoma-Specific Antigens; D008875:Middle Aged; D014442:Monophenol Monooxygenase / Q000235:genetics; D009363:Neoplasm Proteins / Q000235:genetics; D018365:Neoplasm, Residual / Q000097:blood; D009360:Neoplastic Cells, Circulating; D011237:Predictive Value of Tests; D011379:Prognosis; D012333:RNA, Messenger / Q000378:metabolism; D012334:RNA, Neoplasm / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000097:blood* / Q000175:diagnosis
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D058965:MART-1 Antigen; C548667:MLANA protein, human; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins; D012333:RNA, Messenger; D012334:RNA, Neoplasm; D014442:Monophenol Monooxygenase