Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

Abstract

Dec 9. Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for nonsentinel lymph node involvement and overall survival in melanoma patients: a single centre observational cohort study. Quaglino P, Ribero S, Osella-Abate S, Macrì L, Grassi M, Caliendo V, Asioli S, Sapino A, Macripò G, Savoia P, Bernengo MG.You may download, copy and otherwise use the AAM for non-commercial purposes provided that your license is limited by the following restrictions:(1) You may use this AAM for non-commercial purposes only under the terms of the CC-BY-NC-ND license.(2) The integrity of the work and identification of the author, copyright owner, and publisher must be preserved in any copy. AbstractObjective: Completion Lymph Node Dissection (CLND) is the current standard of practice for patients with a positive Sentinel Lymph Node Biopsy (SLNB). Significant morbidity is associated to CLND, so we tried to evaluate which prognostic variables could predict NSLN invasion in SLN-positive patients and their impact on the overall survival (OS). Methods: A retrospective chart review of 603 patients that had undergone SLNB for melanoma between 2000 and 2009 at our department was done. 100 SLN were positive at the histopathological analysis of SLN. Demographic variables, primary melanoma, SLN pathologic features and results of CLND were analysed. Multivariate logistic regression and OS analyses were carried out to test the prognostic relevance of clinicopathologic variables on CLND results and disease course. Results: Breslow thickness, ulceration and micro/macrometastatic pattern of SLN invasion carried a significantly independent higher likelihood of NSLN involvement; Starz classification did not maintain a statistical significance in multivariate analysis. Only one patient (4.3%) without adverse prognostic factors showed NSLN involvement, which was found in 33.3% of patients with one and 55.9% with two or more adverse parameters (p = 0.0001). OS analyses confirmed the prognostic significance of these factors. Conclusion: Waiting for the results of Multicenter Selective Lymphadenectomy Trial II, our study suggests a clinically useful and easily applicable means of identifying patients with an unfavourable disease course. The presence of one or more adverse factors identifies patients in whom CLND is mandatory to include thereafter in a more strict follow-up program. Moreover, the finding of no adverse prognostic indicators associated to the presence of significant co-morbidities and/or elderly age, could be useful in identifying patients not to treat by CLND.

Completion Node Dissection in Patients with Sentinel Node–Positive Melanoma of the Head and Neck

“…2,11,12 To test this notion, we further selected only those patients from our original low-risk group (nonulcerated thin [2 mm] tumors) who had at least 3 SLN harvested, of which only 1 was positive for metastasis ( Figure 4). Remarkably, among those age \60 years, CLND significantly reduced risk of death from melanoma (P = .003).…”

Multiple Lymph Node Basin Drainage in Trunk Melanoma Is Not Associated with Survival of Sentinel Lymph Node-Positive Patients

“…Many studies have established the role of younger age, greater Breslow thickness, ulceration, and tumour mitotic rate in predicting SLN metastases [3][4][5] .…”

SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study

“…However, statistical data reviewed from the literature on these factors are still very poor so that currently none of these parameters can give a safe a reliable prognostic indication on NSLNs status. Previous studies have shown that several characteristics of deposits of metastatic melanoma in SLNs correlate with the presence of tumour in NSLNs in subsequent CLND specimens [17,21-24]. In our study, the microanatomic features of the SLNs metastasis, particularly the tumour penetrative depth of the deposit (according with Starz classification) and several clinic-pathologic data were analyzed looking for a predictive marker for NSLN involvement.…”

“…As reported in literature, only the 14%-18% of positive patients will harbour further disease in the affected basin [14-17]. Only patients with secondary involvement in NSLNs find benefit in a CLND while a large percentage of patients (NSLNs negative) will increase only the morbidity rate due to this surgical procedure [18].…”