title: Identification of high-risk cutaneous melanoma tumors is improved when combining the online American Joint Committee on Cancer Individualized Melanoma Patient Outcome Prediction Tool with a 31-gene expression profile-based classification.
abstract: BACKGROUND
  A significant proportion of patients with American Joint Committee on Cancer (AJCC)-defined early-stage cutaneous melanoma have disease recurrence and die. A 31-gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described.
  
  
  OBJECTIVE
  We sought to compare accuracy of the GEP in combination with risk determined using the web-based AJCC Individualized Melanoma Patient Outcome Prediction Tool.
  
  
  METHODS
  GEP results from 205 stage I/II cutaneous melanomas with sufficient clinical data for prognostication using the AJCC tool were classified as low (class 1) or high (class 2) risk. Two 5-year overall survival cutoffs (AJCC 79% and 68%), reflecting survival for patients with stage IIA or IIB disease, respectively, were assigned for binary AJCC risk.
  
  
  RESULTS
  Cox univariate analysis revealed significant risk classification of distant metastasis-free and overall survival (hazard ratio range 3.2-9.4, P < .001) for both tools. In all, 43 (21%) cases had discordant GEP and AJCC classification (using 79% cutoff). Eleven of 13 (85%) deaths in that group were predicted as high risk by GEP but low risk by AJCC.
  
  
  CONCLUSIONS
  Specimens reflect tertiary care center referrals; more effective therapies have been approved for clinical use after accrual.
  
  
  CONCLUSIONS
  The GEP provides valuable prognostic information and improves identification of high-risk melanomas when used together with the AJCC online prediction tool.
authors.affiliation: Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: ferrlk@upmc.edu.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Ferris
authors.affiliation: National Society for Cutaneous Medicine, New York, New York.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Farberg
authors.affiliation: Castle Biosciences Inc, Friendswood, Texas.
authors.forename: Brooke
authors.initials: B
authors.lastname: Middlebrook
authors.affiliation: Castle Biosciences Inc, Friendswood, Texas.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Johnson
authors.affiliation: Castle Biosciences Inc, Friendswood, Texas.
authors.forename: Natalie
authors.initials: N
authors.lastname: Lassen
authors.affiliation: Castle Biosciences Inc, Friendswood, Texas.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Oelschlager
authors.affiliation: Castle Biosciences Inc, Friendswood, Texas.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Maetzold
authors.affiliation: Castle Biosciences Inc, Friendswood, Texas.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Cook
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Rigel
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Pedram
authors.initials: P
authors.lastname: Gerami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053208:Kaplan-Meier Estimate; D008545:Melanoma / Q000235:genetics* / Q000556:secondary*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000235:genetics*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012878:Skin Neoplasms / Q000235:genetics* / Q000473:pathology*; D015996:Survival Rate; D059467:Transcriptome; D055815:Young Adult
keywords: American Joint Committee on Cancer; cutaneous melanoma; gene expression profile; metastasis; prognosis; staging