title: Nomograms to predict recurrence and survival in stage IIIB and IIIC melanoma after therapeutic lymphadenectomy.
abstract: BACKGROUND
  Current staging algorithms in melanoma patients undergoing therapeutic lymph node dissection (LND) fail to accurately distinguish long-term survivors from those at risk of rapid relapse. Our goal was to establish and validate nomograms for predicting both recurrence and survival after LND.
  
  
  METHODS
  A prospective cohort of stage IIIB and IIIC melanoma patients was ascertained from a tertiary hospital in Brisbane, Australia. Failure-time multivariate analysis identified key factors that, in adjusted combinations, generated nomograms to predict 2-year recurrence and 5-year melanoma-specific survival. The predictive value of these nomograms was further validated in a patient cohort from Rotterdam, The Netherlands.
  
  
  RESULTS
  In 494 Australian patients, number of positive lymph nodes, extra-capsular extension and nodular histopathological subtype were the main independent predictors of 2-year recurrence while age, number of positive nodes and extra-capsular extension were the independent predictors of survival. Predictive value was confirmed in The Netherlands cohort of 331 patients. The nomograms were able to classify patients according to their 2-year recurrence and 5-year survival rates even within each stage III sub-class.
  
  
  CONCLUSIONS
  Models that include extra-capsular extension predict outcomes in patients with clinically involved lymph nodes. This tool may help tailor treatment and monitoring of this group of patients.
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia; The University of Queensland, UQ Diamantina Institute, Translational Research Institute, Woolloongabba, QLD, Australia. Electronic address: k.khosrotehrani@uq.edu.au.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Khosrotehrani
authors.affiliation: Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Augustinus P T
authors.initials: AP
authors.lastname: van der Ploeg
authors.affiliation: QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia.
authors.forename: Victor
authors.initials: V
authors.lastname: Siskind
authors.affiliation: QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia.
authors.forename: Maria Celia
authors.initials: MC
authors.lastname: Hughes
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia.
authors.forename: Annaliesa
authors.initials: A
authors.lastname: Wright
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Janine
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Barbour
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Allan
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: Bayley
authors.affiliation: Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Institut de Cancérologie Gustave Roussy, Villejuif-Paris, France.
authors.forename: Alexander
authors.initials: A
authors.lastname: Eggermont
authors.affiliation: Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
authors.forename: B Mark
authors.initials: BM
authors.lastname: Smithers
authors.affiliation: QIMR Berghofer Medical Research Institute, Cancer and Population Studies Group, Brisbane, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Adele C
authors.initials: AC
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009426:Netherlands / Q000453:epidemiology; D049451:Nomograms; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011793:Queensland / Q000453:epidemiology; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis
keywords: Melanoma; Metastasis; Nomogram; Prognosis; lymph