Predicting Recurrence In Patients With Sentinel Node-Negative Melanoma: Validation Of Theeortcnomogram Using Population-Based Data

Background Identifying patients with sentinel node (SN)-negative melanoma who are at greatest risk of recurrence is important. The European Organization for Research and Treatment of Cancer (EORTC) Melanoma Group proposed a prognostic model that has not been validated in population-based data. The EORTC nomogram includes Breslow thickness, ulceration status and anatomical location as parameters. The aim of this study was to validate the EORTC model externally using a large national data set. Methods Adults with histologically proven, invasive cutaneous melanoma with a negative SN biopsy in the Netherlands between 2000 and 2014 were identified from the Dutch Pathology Registry, and relevant data were extracted. The EORTC nomogram was used to predict recurrence-free survival. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration. Results A total of 8795 patients met the eligibility criteria, of whom 14 center dot 7 per cent subsequently developed metastatic disease. Of these recurrences, 20 center dot 9 per cent occurred after the first 5 years of follow-up. Validation of the EORTC nomogram showed a C-statistic of 0 center dot 70 (95 per cent c.i. 0 center dot 68 to 0 center dot 71) for recurrence-free survival, with excellent calibration (R-2 = 0 center dot 99;P = 0 center dot 999, Hosmer-Lemeshow test). Conclusion This population-based validation confirmed the value of the EORTC nomogram in predicting recurrence-free survival in patients with SN-negative melanoma. The EORTC nomogram could be used in clinical practice for personalizing follow-up and selecting high-risk patients for trials of adjuvant systemic therapy.