Patient outcome prediction using multiple biomarkers in human melanoma: A clinicopathological study of 118 cases

The application of biomarkers in melanoma prognosis has been well recognized. However the ability of a single biomarker to predict melanoma patient outcome is usually limited. We previously examined the expression of ten biomarkers (Bim, BRG1, BRMS1, CTHRC1, ING4, NQO1, NF-κB-p50, PUMA, SNF5 and SOX4) in melanomas. To assess the value of a combined multiple biomarker system in melanoma prognosis, we compared the expression of each biomarker between various stages of melanoma, and determined the best combination of biomarkers for melanoma prognosis. Although the expression of six biomarkers (Bim, BRMS1, ING4, NQO1, PUMA and SOX4) was significantly decreased in AJCC III-IV stages of melanoma compared to AJCC I-II stages, the combined 6-biomarker index score exhibited higher variations than any individual biomarker in the same comparison. Moreover, the 6-biomarker index score was correlated with melanoma thickness, location and subtype, and predicted the outcome of melanoma patients more accurately than the individual biomarkers. Multivariate Cox regression analysis demonstrated that the 6-biomarker index score is an independent prognostic factor for melanoma. In conclusion, our study suggests that a multi-biomarker system test is valuable for improved outcome prediction in melanoma patients and for the development of novel therapeutic strategies.