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Updated: May 24, 2026
A Robust Discovery Platform for the Identification of Novel Mediators of Melanoma Metastasis
Published on: March 8, 2022
Development and internal validation of the CLIP-M score for advanced mucosal malignant melanoma: exploratory
Burak Pacaci1, Buket Erkan Ozmarasali2, Adem Deligonul2
1Division of Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, 34854, Turkey. burak.pacaci@marmara.edu.tr.
Background:
Mucosal malignant melanoma (MMM) is a rare, aggressive malignancy with poor prognosis in the advanced setting. Although the Royal Marsden Hospital (RMH) score is widely used in advanced malignancies, its utility in advanced MMM remains insufficiently characterized. We aimed to develop a composite prognostic score and compare its performance with RMH.
Methods:
We analyzed 80 patients with advanced MMM (metastatic or unresectable) from a multicenter database. Pretreatment inflammatory indices and clinical variables were evaluated. The CLIP-M score (Clinical and Inflammatory Prognostic Score in Mucosal Melanoma) was derived from independent predictors in multivariable Cox regression and internally validated by bootstrap resampling. Predictive accuracy was compared with RMH using time-dependent AUCs, Harrell's C-index, and Kaplan-Meier estimates.
Results:
During a median follow-up of 65.2 months, 63 deaths occurred. SII was selected as the biological component. CLIP-M integrated high SII (≥ 789; derived by 12-month time-dependent ROC analysis), age ≥ 65 years, and non-head & neck primary location. Time-dependent AUCs numerically favored CLIP-M over RMH at 12 months (0.731 vs. 0.613), 24 months (0.824 vs. 0.680), and 36 months (0.863 vs. 0.697), with a nominal 36-month between-model difference that did not remain significant after correction for three time horizons (ΔAUC = 0.166; nominal p = 0.039). Bootstrap internal validation showed moderate discrimination, with apparent and optimism-corrected C-indices of 0.648, and acceptable 12-month calibration. CLIP-M stratified patients into low-risk (score 0-1) and high-risk (score 2-3) groups with divergent median overall survival (24.8 vs. 6.4 months; HR 4.03, 95% CI 2.25-7.22; p < 0.001).
Conclusion:
CLIP-M provided exploratory, clinically interpretable risk stratification in advanced MMM and showed numerically higher discrimination than RMH; however, optimism-corrected performance was moderate and external validation is required before clinical implementation.
Insights
A new prognostic score, CLIP-M, shows promise for advanced mucosal malignant melanoma (MMM). It integrates clinical and inflammatory factors, offering better risk stratification than the RMH score, though external validation is needed.
Area of Science:
- Oncology
- Medical Statistics
Background:
- Mucosal malignant melanoma (MMM) is a rare, aggressive cancer with a poor prognosis in advanced stages.
- The utility of the Royal Marsden Hospital (RMH) score in advanced MMM is not well-established.
Purpose of the Study:
- To develop a novel composite prognostic score for advanced MMM.
- To compare the performance of the new score against the RMH score.
Main Methods:
- Analysis of 80 patients with advanced MMM from a multicenter database.
- Development of the CLIP-M score using multivariable Cox regression on pretreatment inflammatory indices and clinical variables.
- Internal validation using bootstrap resampling and comparison with RMH score via time-dependent AUCs and Harrell's C-index.
Main Results:
- The CLIP-M score integrates high SII, age ≥65 years, and non-head & neck primary location.
- CLIP-M demonstrated numerically superior predictive accuracy compared to RMH at 12, 24, and 36 months.
- CLIP-M successfully stratified patients into low-risk and high-risk groups with significantly different overall survival.
Conclusions:
- The CLIP-M score offers exploratory, clinically interpretable risk stratification for advanced MMM.
- CLIP-M showed numerically higher discrimination than the RMH score.
- External validation is necessary before widespread clinical implementation of CLIP-M.
