subgroup of patients with T1 tumors predicted to have 5%-10% risk of SLN positivity by the NCCN guidelines resulted in restratification (risk prediction downgrading to <5% or upgrad-ing to >10%) in 63% of cases. Data on recurrence-free, distant metastasis-free, and overall survival calculated in a subset of 312 patients with long-term follow-up corresponded with the i31-GEP SLN positivity predictions. These analyses showed that patients with an i31-GEP predicted <5% risk of SLN positivity had significantly better outcomes for all three endpoints relative to both their node-positive and node-negative counterparts with a ≥5% predicted SLN positivity likelihood. TO READ MORE: Whitman ED, Koshenkov VP, Gastman BR, et al. Integrating 31-gene expression profiling with clinicopathologic features to optimize cutaneous melanoma sentinel lymph node metastasis predic-tion. JCO Precis Oncol. 2021;5.21.00162. doi:10.1200/PO.21.00162. lance, Epidemiology and End Results (SEER) Program and Castle Biosciences. It linked 4,687 patients with stage I-III cutaneous melanoma who had a 31-GEP test between 2016 and 2018 to SEER registry data. Using Kaplan-Meier analysis, 3-year melanoma-specific survival (MSS) and overall survival (OS) rates were determined with patients stratified by their 31-GEP risk category: low (class 1A), inter-mediate (class 1B/2A), and high (class 2B). The results showed that both the MSS and OS rates decreased across worsening risk category. The differences in survival rates between risk catego-ry groups were analyzed using the log-rank test and showed that patients in the low risk 31-GEP group had significantly higher survival rates than those with an intermediate or high risk 31-GEP result (MSS: 99.7% vs 97.1% vs 89.6%, P < .001; OS: 96.6% vs 90.2% vs 79.4%; P <.001). The investigators also performed a multivariable Cox regression analysis to identify independent predictors of survival in the 31-GEP-tested cohort. Using the 31-GEP low risk cohort group as the reference group, the results showed that both an intermediate 31-GEP result and a high risk 31-GEP result were independent predictors of both MSS (intermediate risk: hazard ratio [HR], 4.86; 95% confidence interval [CI], 1.97 to 12.03; high risk: HR 7.00; 95% CI, 2.70 to 18.00) and OS (intermediate risk: HR, 2.22; 95% CI,1.51 to 3.25; high risk: HR, 2.39; 95% CI, 1.54 to 3.70). MSS and OS mortality rates were also compared between the entire 31-GEP tested cohort and a propensity score-matched group of patients identified in the SEER database who did not have 31-GEP testing. Results of the Cox pro-portional hazards analysis showed significantly better outcomes for both endpoints among pa-tients who had 31-GEP testing. Compared to the untested group, 31-GEP testing was associated with a 29% lower MSS mortality rate (HR, 0.71; 95% CI, 0.53 to 0.94) and a 17% lower overall mortality rate (HR, 0.83; 95% CI, 0.70 to 0.99). The robustness of the findings was confirmed when the analyses were repeated using 1,000 randomly resampled subsets of qualified, untest-ed patients. TO READ MORE: Bailey CN, Martin BJ, Petkov VI, et al. 31-gene expression profile testing in cutaneous melanoma and survival outcomes in a population-based analysis: a SEER collaboration. JCO Precis Oncol. 2023;7. doi:10.1200/PO.23.00044. The authors observed that the significant additional prognostic information on survival provided by integrating tumor molecular characteristics using the 31-GEP test may allow clinicians to make more precise risk assessment and more personalized clinical management decisions for patients with cutaneous melanoma, which may improve patient outcomes. Real-world Study Data Demonstrate 31-GEP Test Performance for Predicting Survival Outcomes of Cuta-neous Melanoma Patients A population-based study analyzing real-world data confirms the ability of the 31-gene expres-sion profile (31-GEP) test to stratify patients with stage I-III cutaneous melanoma by risk of dying from their skin cancer. The research also showed that the test was an independent predic-tor of 3-year survival outcomes and that patients who had the test had significantly higher 3-year survival rates compared to a propensity score-matched cohort of non-tested patients. Commenting on the relevance of the findings, which were published in JCO Precision Oncology , the authors observed that the significant addi-tional prognostic information on survival pro-vided by integrating tumor molecular character-istics using the 31-GEP test may allow clinicians to make more precise risk assessment and more personalized clinical management decisions for patients with cutaneous melanoma, which may improve patient outcomes. The study was conducted as a collaboration between the National Cancer Institute’s Surveil-4 | The Dermatology Digest
The Dermatology Digest Innovations in Personalized Medicine November/December 2024 Supplement: Page 4
