Background:Neoadjuvant and adjuvant therapies are currently getting increasingly important in cutaneous melanoma (CM) management. However, there is still a lack of prognostic tools to identify which patients have a poor prognosis. There is increasing evidence that the liver score may be a potential prognostic parameter in different tumour types. The aim was to investigate whether established liver scores can establish the prognosis of CM.Methods:According to established methods, the APRI, the MELD score, the MELD-Na score and the De Ritis ratio were calculated from the laboratory values at the time of the initial diagnosis. Survival was compared with the Kaplan–Meier curve and tested with log-rank tests. Risk factors associated with cutaneous melanoma-specific survival (CMSS) and progression-free survival (PFS) were assessed by using the Cox proportional hazards regression model. To determine the diagnostic accuracy, we performed a time-dependent ROC analysis. Results: A total of 423 patients were included, including 141 patients in AJCC stage (2017) I (33.3%), 82 in stage II (19.4%), 128 in stage III (30.3%) and 72 in stage IV (17%). Median time until melanoma-specific death was 99 months (IQR: 37–126). In addition, 37.6% of patients relapsed with a median time to relapse of 88 months (IQR: 17.5–126). In all stages, tumour thickness and ulceration were independent markers for predicting CMSS and PFS (p< 0.05). The multivariable analysis with all stages showed no significant association with CM outcome for liver scores (p> 0.05). The subgroup analysis revealed that the APRI (≥0.2241) was associated with CMSS and PFS in melanoma stages I and II, independently of tumour thickness, age and ulceration (HR 2.57, 95% CI 1.14–5.75; HR 2.94, 95% CI 1.42–6.09, respectively).Conclusions:The 20-year prognosis of AJCC stage I and II CM was dependent on tumour thickness and the APRI. High tumour thickness and an APRI ≥ 0.2241 at the initial diagnosis were associated with a worse prognosis. Future studies should investigate the independent prognostic value of the APRI in low-stage CM. Furthermore, the APRI score could be a potential biomarker for nomograms.
背景：新辅助与辅助疗法在皮肤黑色素瘤（CM）治疗中的重要性日益凸显，但目前仍缺乏有效的预后工具来识别预后不良的患者。越来越多的证据表明，肝脏评分可能成为多种肿瘤类型的潜在预后参数。本研究旨在探讨已建立的肝脏评分系统是否能够预测CM的预后。 方法：根据既定方法，利用初诊时的实验室检测值计算APRI评分、MELD评分、MELD-Na评分及De Ritis比值。采用Kaplan-Meier曲线比较生存情况，并通过时序检验进行验证。使用Cox比例风险回归模型评估与皮肤黑色素瘤特异性生存（CMSS）和无进展生存期（PFS）相关的风险因素。为确定诊断准确性，我们进行了时间依赖性ROC分析。 结果：共纳入423例患者，其中AJCC（2017版）分期I期141例（33.3%）、II期82例（19.4%）、III期128例（30.3%）、IV期72例（17%）。黑色素瘤特异性死亡中位时间为99个月（IQR：37-126）。此外，37.6%的患者出现复发，中位复发时间为88个月（IQR：17.5-126）。在所有分期中，肿瘤厚度和溃疡是预测CMSS和PFS的独立标志物（p<0.05）。全分期多变量分析显示，肝脏评分与CM预后无显著相关性（p>0.05）。亚组分析表明，在I期和II期黑色素瘤中，APRI评分（≥0.2241）与CMSS和PFS独立相关，且不受肿瘤厚度、年龄和溃疡状态影响（风险比分别为2.57，95%置信区间1.14-5.75；2.94，1.42-6.09）。 结论：AJCC I期和II期CM的20年预后取决于肿瘤厚度和APRI评分。初诊时较高的肿瘤厚度和APRI≥0.2241与不良预后相关。未来研究应进一步探讨APRI在低分期CM中的独立预后价值。此外，APRI评分可能成为列线图的潜在生物标志物。
Analysis of Calculated Liver Scores for Long-Term Outcome in 423 Cutaneous Melanoma Patients
肿瘤(癌症)患者之家