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Outcomes/Effectiveness Research

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Study validates American Joint Committee on Cancer's survival rates for stage IV melanoma

Patients who are diagnosed with stage IV melanoma (skin cancer) typically live less than a year, according to the 2002 American Joint Committee on Cancer (AJCC) staging system. A new study validated the AJCC system by using the center's melanoma database. A database search found 589 patients who were diagnosed with stage IV disease at the center from July 1997 to March 2006. Consistent with the literature, the median survival length for these patients was 9 months with a 1-year survival rate of 39 percent and a 5-year rate of 9 percent.

The study found several factors that appear to affect survival rates. Older age at the time of diagnosis was associated with poorer survival rates. This finding had not been observed in prior studies. High levels of lactate dehydrogenase, an enzyme that can be measured to determine tissue damage, were associated with poor survival rates. A greater number of organs affected by the cancer also indicated a poor prognosis. The number of metastases, or additional tumors indicating the cancer's spread, was a strong predictor of survival. Patients with one metastasis lived a median of 23 months, while patients who had more than one affected site lived just 8 months.

These findings on metastases may be useful in developing future staging systems, the authors suggest. However, they caution that advances in imaging technology may create challenges in determining the difference between true metastases and imaging artifacts. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00066).

See "A single-institution validation of the AJCC staging system for stage IV melanoma," by Heather B. Neuman, M.D., Ami Patel, B.A., Nicole Ishill, M.S., and others in the July 2008 Annals of Surgical Oncology 15(7), pp. 2034-2041.

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