The following is a summary of “Optimizing treatment approaches for patients with cutaneous melanoma by integrating clinical and pathologic features with the 31-gene expression profile test,” published in the December 2022 issue of Dermatology by Jarell, et al.
While many higher advanced individuals do not, many low-stage patients with cutaneous melanoma may have tumor recurrence, metastasis, or death. Therefore, for a study, researchers sought to create an algorithm using the clinicopathologic data and the 31-gene expression profile test for an optimized, personalized risk of recurrence (integrated 31 risks of recurrence [i31-ROR]) or death and to use i31-ROR in conjunction with a previously validated algorithm for accurate sentinel lymph node positivity risk estimates (i31-SLNB) for optimized treatment plan decisions.
On a cohort of patients with stage I-III melanoma, Cox regression models for ROR were created (n = 1,581) and independently verified (n = 523). In addition, the performance of the i31-ROR was assessed using National Comprehensive Cancer Network cut points, utilizing the midpoint survival rates between patients with stage IIA and stage IIB illness as a risk threshold.
In comparison to patients with a high-risk i31-ROR result, patients with a low-risk i31-ROR result had substantially greater 5-year recurrence-free survival (91% vs 45%, P< .001), higher metastasis-free survival (95% vs 53%, P< .001), and melanoma-specific survival (98% vs 73%, P< .001). In 44% of patients, sentinel lymph node biopsy could be skipped while still maintaining excellent survival rates (>98%) or they were reclassified as having a higher or lower risk of recurrence or death, according to a combined i31-SLNB/ROR study.
Comparatively to clinicopathologic variables alone, the integration of clinicopathologic data with the 31-GEP enhanced patient risk categorization.