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The Prognostic Importance of Tumor Mitotic Rate Confirmed in 1317 Patients With Primary Cutaneous Melanoma and Long Follow-Up

Anne Brecht Francken, MD, Helen M. Shaw, PhD, John F. Thompson, MD, Seng-jaw Soong, PhD, Neil A. Accortt, PhD, Manuela F. Azzola, MD, Richard A. Scolyer, MBBS, Gerald W. Milton, MBBS, William H. McCarthy, MBBS, Marjorie H. Colman, BSc and Vincent J. McGovern, MD

From the Sydney Melanoma Unit (ABF, HMS, JFT, MFA, GWM, WHMcC, MHC) and Department of Anatomical Pathology (RAS, VJMcG), Royal Prince Alfred Hospital, Sydney, NSW, Australia; and the Biostatistics and Bioinformatic Unit (S-JS, NAA), Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.

Correspondence: Address correspondence and reprint requests to: John F. Thompson, MD, Sydney Melanoma Unit, Royal Prince Alfred Hospital, Missenden Rd., Camperdown, New South Wales 2050, Australia; Fax: 61-2-9550-6316; E-mail: thompson{at}smu.org.au

Background: The late Dr. Vincent McGovern (1915 to 1983) was an international authority on melanoma pathology and one of the first to suggest that assessment of tumor mitotic rate (TMR) might provide useful prognostic information. Data for a large cohort of patients, now with extended follow-up, whose tumors had been assessed by Dr. McGovern were analyzed to reassess the independent prognostic value of TMR in primary localized, cutaneous melanoma.

Methods: Information was extracted from the Sydney Melanoma Unit database for 1317 patients treated between 1957 and 1982 for whom there was complete clinical information and whose primary lesion pathology, which included tumor thickness, ulcerative state, and TMR, had been assessed by Dr. McGovern. All these assessments were made according to the recommendations of the Eighth International Pigment Cell Conference, held in Sydney in 1972 under the auspices of the International Union Against Cancer. Factors predicting melanoma-specific survival were analyzed with the Cox proportional hazards regression model.

Results: Stage, according to the recently revised American Joint Committee on Cancer Staging System (which is based on tumor thickness and ulceration) was the most predictive factor for survival (P < .0001). This was followed by primary lesion site (P < .0001), patient age (P = .0005), and TMR (P = .008).

Conclusions: TMR was confirmed to be an important independent predictor of survival of patients with primary cutaneous melanoma. However, its predictive value was less than it was when assessed according to the 1982 revisions of the 1972 TMR recommendations.

Key Words: Primary melanoma • Prognosis • Staging • Thickness • Tumor mitotic rate

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