Comparison of classification systems in melanoma sentinel lymph nodes—An analysis of 697 patients from a single center

Abstract

BACKGROUND:In melanoma, different classification systems have been proposed that predict overall survival (OS) and recurrence-free survival (RFS) based on findings in the sentinel lymph node (SLN). The authors of this report compared the RFS and OS of 697 melanoma patients as predicted by various classification systems. METHODS: The Rotterdam system (based on the greatest dimension of the largest tumor cell deposit), the Augsburg S-classification (based on tumor penetrative depth [TPD]), and the Hannover system (based on a combination of tumor load, TPD, and invasion of the capsule) were studied in 697 consecutive melanoma patients who underwent SLN biopsy at the authors' center. RESULTS: In univariate analyses, the Rotterdam and Hannover systems (but not the S-classification) identified 1 group of SLN-positive patients that had OS and RFS similar to the OS and RFS of SLN-negative patients. The intermediate groups from all classification systems did not differ significantly with regard to RFS and/or OS from the adjacent groups. In multivariate analysis using a Cox model, the greatest dimension of the largest tumor cell deposit (cutoff point, <0.1 mm vs 0.1 mm), the TPD (cutoff point, 2 mm vs >2 mm), and capsular involvement represented independent parameters for RFS; and TPD and capsular involvement also were independent parameters for OS. On the basis of these 3 parameters, a new scoring system for risk assessment in patients with melanoma is proposed that can distinguish 3 separate groups of patients that differed significantly in OS and RFS. CONCLUSIONS: Different parameters of independent prognostic significance were identified in SLNs from patients with melanoma. Combining these parameters, the prognosis of patients with melanoma was predicted more precisely by the new scoring system than by currently published classification systems. Cancer 2010;116:3178-88.

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

“…Roka et al [8] reported an SLN tumour size >2 mm, presence of NSLN involvement and Breslow thickness to be associated with different recurrence-free and disease-specific survival and confirmed the prognostic relevance of the S/U score proposed by Reeves et al [20] In another paper, the presence of micro-metastatic tumour deposits in SLN was associated to a significantly better prognosis with respect to macrometastases [9]. A recent German study [39] found the greatest dimension of the largest tumour cell deposit, the tumour penetrative depth and capsular involvement as independent parameters for relapsefree and overall survival. The invasion depth (Starz classification) [17] was also found by previous studies to best predict overall survival [16], [18] and [40].…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…In a comparative study, two protocols (lamination and halving according to EORTC recommendations) were equivalent in detecting melanoma metastases in the sentinel lymph node [189]. Using these protocols, various studies have shown 25-30 % of melanoma patients with a primary tumor > 1 mm to be positive [189][190][191][192][193][194][195][196].…”

“…However, some parameters are looming, which have prognostic relevance or may be able to predict involvement of further, non-sentinel lymph nodes in the affected basin. In particular, they include length of the largest melanoma cell cluster [193,196,204,205], maximum depth of melanoma cell penetration from the lymph node capsule into the lymph node parenchyma [191,193,195], infiltration of the lymph node capsule [190,193], lymphangiosis, i.e. accumulation of tumor cells within lymph vessels outside the sentinel lymph node [204][205][206], and location of melanoma cells inside the lymph node, e.g.…”

“…Further comparative studies with sufficiently long follow-up intervals are necessary [19,193]. Based on current data, specification of the following parameters in the report are recommended: 1. largest diameter of the largest tumor cell cluster in tenths of millimeters, 2. maximum depth of melanoma cell penetration from the inner side of the lymph node capsule into the lymph node parenchyma, 3. invasion of melanoma cells into the lymph node capsule or capsular rupture, 4. location of melanoma cells in perinodal lymph vessels (lymphangiosis), as this increases the likelihood for further lymph node involvement.…”

“…Systematic search of the literature de-novo: [17,193,209,210] Strength of consensus: 100 % R. Gutzmer Sentinel lymph node status (determined as positive or negative) is a significant and statistically independent parameter for the prognosis of melanoma patients [17,209]. Various studies have been able to demonstrate a correlation between tumor load or tumor cell location in the lymph node parenchyma and prognosis.…”