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Molecular risk prediction in cutaneous melanoma: a meta-analysis of the 31-gene expression profile prognostic test in 1,479 patients
Journal of the American Academy of Dermatology ( IF 7.102 ) Pub Date : 2020-03-27 , DOI: 10.1016/j.jaad.2020.03.053
Bradley N. Greenhaw; Kyle R. Covington; Sarah J. Kurley; Yildiray Yeniay; Nhat Anh Cao; Kristen M. Plasseraud; Robert W. Cook; Eddy C. Hsueh; Brian R. Gastman; Maria L. Wei

Background Multiple studies have reported on the accuracy of the prognostic 31-gene expression profile test (31-GEP) for cutaneous melanoma. Consistency of the test results across studies has not been systematically evaluated. Objective To assess the robustness of the prognostic value of the 31-GEP. Methods Raw data were obtained from studies identified from systematic review. A meta-analysis was performed to determine overall effect of the 31-GEP. Clinical outcome metrics for the 31-GEP were compared to AJCC staging. Results Three studies met inclusion criteria; data from a novel cohort of 211 patients were included (n=1,479). Five-year recurrence-free and distant metastasis-free survival (DMFS) rates were 91.4% and 94.1% for Class 1A patients and 43.6% and 55.5% for Class 2B patients (p<0.0001). Meta-analysis results show that Class 2 was significantly associated with recurrence (HR: 2.90; p<0.0001) and distant metastasis (HR: 2.75; p<0.0001). The 31-GEP identified AJCC stage I-III patient subsets with high likelihood for recurrence and distant metastasis. Sensitivity was 76% [95%CI 71-80%] and 76% [95%CI 70-82%] for each endpoint, respectively. When 31-GEP and sentinel lymph node biopsy results were considered together, sensitivity and negative predictive value for DMFS were both improved. Conclusion The 31-GEP test consistently and accurately identifies melanoma patients at increased risk of metastasis, is independent of other clinicopathologic covariates, and augments current risk stratification by re-classifying patients previously designated as low risk, for heightened surveillance.
更新日期:2020-03-28

 

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