ArticleVirchows Archiv : an international journal of pathology2026
Prognostic significance of histopathologically assessed tumor mitotic rate in T1-T4 cutaneous melanoma in the AJCC 8th edition era (2018-2022).
Article in Virchows Archiv : an international journal of pathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Cutaneous melanoma (CM) is a highly metastatic malignancy where accurate risk stratification is vital for prognosis. Although tumor mitotic rate (TMR) was removed from T1 staging in the AJCC 8th edition, it remains a critical marker of proliferation. This study utilizes the SEER database (2018-2022) to evaluate the prognostic significance of a five-tier TMR stratification across T1-T4 categories, providing a contemporary assessment of its impact on disease-specific survival (DSS). Data for 85,450 patients aged ≥20 years with malignant CM were extracted from the SEER 17 database (2018-2022). After excluding cases with missing ulceration, TMR, staging, or survival data, TMR was categorized into five tiers (0, 1, 2-3, 4-10, >10 mitoses/mm²). Statistical analyses, performed via IBM SPSS v31.0, included Pearson chi-square tests for baseline characteristics, Kaplan-Meier curves for survival estimation, and multivariable Cox regression to identify independent prognostic factors for DSS across T1-T4 stages. Mitotic activity (TMR ≥1) and ulceration were present in 41.9% and 13.7% of patients, respectively. TMR significantly associated with all clinicopathological variables (p < 0.001). Multivariable analysis revealed nuanced stage-specific patterns: in T1 tumors, TMR became comparable to ulceration at 2-3 mitoses/mm² and surpassed it at ≥4 mitoses/mm², while in T2 tumors, ulceration remained a more potent marker. Conversely, TMR consistently outperformed ulceration across all T3 and T4 categories. A significant stepwise increase in the risk of DSS was observed across higher TMR categories in all T stages. Our findings demonstrate that TMR is an independent prognostic factor whose impact fluctuates by T stage, often rivaling or exceeding the predictive value of ulceration. These results support the integration of multi-tiered mitotic reporting into clinical practice and suggest that refined TMR stratification could enhance the precision of future melanoma prognostic models.
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