title: The prognostic value of tumor mitotic rate and other clinicopathologic factors in patients with locoregional recurrences of melanoma.
abstract: BACKGROUND
  Tumor mitotic rate (MRP) is an independent prognostic factor in clinically localized primary cutaneous melanoma, but the prognostic importance of mitotic rate in melanoma recurrences (MRR) is not known. In this study, we sought to determine the prognostic value of MRR and other clinicopathologic factors in recurrent melanoma.
  
  
  METHODS
  Patients with primary cutaneous melanoma diagnosed between 1979 and 2006, who subsequently developed recurrence(s), were studied. Histologic sections of primary and first locoregional recurrences of melanoma were examined, and MRP and MRR were measured. Relationships between MRR, known prognostic parameters in melanoma, time to first recurrence (TTR), and postrecurrence survival were analyzed.
  
  
  RESULTS
  A total of 279 patients (172 men, 107 women) had AJCC stage I (n = 97) or stage II (n = 182) melanoma. Median MRP and MRR were 4/mm(2) (0-34) and 4/mm(2) (0-51), respectively. There was weak association between MRP and MRR (R (2) = 0.02, p = 0.02). Independent predictors of poorer postrecurrence survival were shorter TTR (hazard ratio, 0.74; 95% confidence interval, 0.61-0.90, p = 0.003) and recurrence type (10-year postrecurrence survival for local, lymph node, and in-transit recurrences: 70%, 21.5%, and 11.1%, respectively; p = 0.04). MRR >0 was associated with poorer 10-year postrecurrence survival (39.1%) than if MRR = 0 (51.2%), but the difference did not reach statistical significance (p = 0.15). However, the difference in survival between patients with MRR >0 and those with MRR = 0 increased with time.
  
  
  CONCLUSIONS
  TTR is an independent predictor of postrecurrence survival. Because survival in patients with MRR >0 decreases with time (relative to those with MRR = 0), MRR should be routinely measured so that future studies can determine whether MRR has any independent predictive value.
authors.affiliation: Royal Prince Alfred Hospital, Sydney, Camperdown, NSW, Australia. rajmohan.murali@sswahs.nsw.gov.au
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Murali
authors.forename: Marc D
authors.initials: MD
authors.lastname: Moncrieff
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hong
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Cooper
authors.forename: Meena V
authors.initials: MV
authors.lastname: Shingde
authors.forename: David G
authors.initials: DG
authors.lastname: Samuel
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D008940:Mitotic Index; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D055815:Young Adult