Prognostic factors and treatment outcomes in 444 patients with mucosal melanoma

Publication date: August 2017
Source:European Journal of Cancer, Volume 81
Author(s): Markus V. Heppt, Alexander Roesch, Benjamin Weide, Ralf Gutzmer, Friedegund Meier, Carmen Loquai, Katharina C. Kähler, Anja Gesierich, Markus Meissner, Dagmar von Bubnoff, Daniela Göppner, Max Schlaak, Claudia Pföhler, Jochen Utikal, Lucie Heinzerling, Ioana Cosgarea, Jutta Engel, Renate Eckel, Alexander Martens, Laura Mirlach, Imke Satzger, Gabriele Schubert-Fritschle, Julia K. Tietze, Carola Berking
BackgroundMucosal melanoma (MM) is a rare but diverse cancer entity. Prognostic factors are not well established for Caucasians with MM.Patients and methodsWe analysed the disease course of 444 patients from 15 German skin cancer centres. Disease progression was determined with the cumulative incidence function. Survival times were estimated with the Kaplan–Meier method. Prognostic parameters were identified with multivariate Cox regression analysis.ResultsCommon anatomic sites of primary tumours were head and neck (MMHN, 37.2%), female genital tract (MMFG, 30.4%) and anorectal region (MMAN, 21.8%). MMAN patients showed the highest vertical tumour thickness (p = 0.001), had a more advanced nodal status (p = 0.014) and a higher percentage of metastatic disease (p = 0.001) at diagnosis. Mutations of NRAS (13.8%), KIT (8.6%) and BRAF (6.4%) were evenly distributed across all tumour site groups. Local relapses were observed in 32.4% and most commonly occurred in the MMHN group (p = 0.016). Male gender (p = 0.047), advanced tumour stage (p = 0.001), nodal disease (p = 0.001) and incomplete resection status (p = 0.001) were independent risk factors for disease progression. Overall survival (OS) was highest in the MMFG group (p = 0.030) and in patients without ulceration (p = 0.004). Multivariate risk factors for OS were M stage at diagnosis (p = 0.002) and incomplete resection of the primary tumour (p = 0.001).ConclusionIn this large series of MM patients in a European population, anorectal MM was associated with the poorest prognosis.



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