Factors Associated With Improved Survival Among Young Adult Melanoma Patients Despite a Greater Incidence of Sentinel Lymph Node Metastasis

Chagpar, Ryaz; Ross, Merrick I.; Reintgen, Douglas S.; Edwards, Michael J.; Scoggins, Charles R.; Martin, Robert C.G.; Noyes, R. Dirk; Goydos, James S.; Beitsch, Peter D.; Urist, Marshall M.; Ariyan, Stephan; Davidson, Bradley S.; Sussman, Jeffrey J.; McMasters, Kelly M.

doi:10.1016/j.jss.2007.04.004

Cited by 26 publications

(16 citation statements)

References 24 publications

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“…By removing occult nodal micrometastasis at the time of diagnosis we potentially eliminate nodal recurrence later and its associated morbidity, psychological stress and poor outcomes. 22,26 CLND was associated with an acceptably low same nodal basin recurrence rate similar to the 7e8% reported in a meta-analysis and substantially better than the nodal failure rate if no CLND is performed. 21,22 Likewise, CLND is a feasible technique to identify and remove occult NSLN metastasis and to further stratify disease-free and melanoma-specific survival.…”

Section: Discussionsupporting

confidence: 72%

“…22,26 CLND was associated with an acceptably low same nodal basin recurrence rate similar to the 7e8% reported in a meta-analysis and substantially better than the nodal failure rate if no CLND is performed. 21,22 Likewise, CLND is a feasible technique to identify and remove occult NSLN metastasis and to further stratify disease-free and melanoma-specific survival. Our median CLND lymph node retrieval was 18 for head and neck and 14 for all other basins.…”

Section: Discussionsupporting

confidence: 72%

“…12,21 Our SLN metastasis rate is similar to published reports of younger cohorts. 22 Distant metastases were significantly less common in SLN negative patients (9.5%) than in SLN positive patients (25%). These data Table 3 Multivariate analysis of disease-free survival (A) and melanoma-specific survival (B).…”

Section: Discussionmentioning

confidence: 89%

“…Possible ways to improve compliance with national guidelines and potentially improve outcomes include education of both patients and referring and treating providers (dermatologists, primary care physicians, otolaryngologists, plastic surgeons, general surgeons, surgical oncologists and medical oncologists) of the risks and benefits of SLNB including the risk of disease recurrence and the resultant increased morbidity and diminished survival associated with treatment of nodal metastasis once they become clinically evident. 22 Complex cases and patients at the extremes of age may be benefit from referral to tertiary care centers.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Management of regional lymph nodes in the elderly melanoma patient: Patient selection, accuracy and prognostic implications

Grotz

Puig

Perkins

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Management of regional lymph nodes in the elderly melanoma patient: Patient selection, accuracy and prognostic implications

Grotz

Puig

Perkins

et al. 2015

European Journal of Surgical Oncology (EJSO)

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“…Together these data suggest that lymphatic dysfunction may be associated with increasing age. This paradoxical observation of poor outcomes and decreased nodal metastasis in the elderly has led some authors to speculate that hematogenous spread of melanoma may be the predominate mechanism of melanoma progression in the elderly [6]. However, age as an independent poor prognostic factor may be more complex than it appears.…”

Section: Introductionmentioning

confidence: 99%

Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes

Grotz

Vaince

Hieken³

2013

Melanoma Research

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Tumor-infiltrating lymphocytes (TILs) and regression are manifestations of the host immune response to tumor, but their influence on outcome remains undefined. There is a paucity of data on the elderly who represent a growing proportion of melanoma patients. The aim of this study was to evaluate the influence of TILs and regression as an indirect measure of immunity on outcome in elderly patients with melanoma. From a prospective database, we identified 250 consecutive cutaneous melanoma patients aged at least 65 years at the time of diagnosis. Data were verified by record review. Within the primary melanoma, a brisk TIL response was present in 66 (31%), nonbrisk TILs in 36 (17%), and absent in 111 (52%). The presence of a brisk infiltrate conferred a three-fold increased risk of sentinel lymph node (SLN) metastasis (P=0.02). Despite this, nonbrisk or absent TILs were associated with a five-fold increased risk of recurrence (P=0.0001). In multivariate analysis, nonbrisk or absent TILs were independently associated with recurrence (P<0.0001), diminished 5-year disease-free survival (76 vs. 91%, P=0.0006), and 5-year melanoma-specific survival (82 vs. 95%, P=0.0008). Regression was not an independent predictor of SLN metastasis, disease-free survival, or melanoma-specific survival. Our study demonstrates that an active antitumor immune response exists in elderly melanoma patients that, paradoxically, predicts both SLN metastasis and improved melanoma-specific outcomes. Further investigation to characterize this lymphocytic infiltrate and to confirm its clinical significance as a predictor of nodal status, patient outcome, and response to immunotherapy in elderly melanoma patients appears warranted.

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Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma

Kyrgidis

Tzellos

Mocellin

et al. 2015

Cochrane Database of Systematic Reviews

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The basis f or the assumed risk (e.g. the m edian control group risk across studies) is provided in f ootnotes. The corresponding risk (and its 95% conf idence interval) is based on the assum ed risk in the com parison group and the relative effect of the intervention (and its 95% CI). CI: Conf idence interval; RR: Risk ratio; HR: Hazard ratio; GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our conf idence in the estim ate of ef f ect. M oderate quality: Further research is likely to have an im portant im pact on our conf idence in the estim ate of ef f ect and m ay change the estim ate. Low quality: Further research is very likely to have an im portant im pact on our conf idence in the estim ate of ef f ect and is likely to change the estim ate. Very low quality: We are very uncertain about the estim ate.1 Published evidence is lim ited to a single random ised trial, so the quality of evidence has been downgraded by one level;given that risk of bias has been rated as 'high' or 'unclear' f or several com ponents, we f urther downgraded the evidence because of this. 2 As-treated analysis.

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Factors Associated With Improved Survival Among Young Adult Melanoma Patients Despite a Greater Incidence of Sentinel Lymph Node Metastasis

Cited by 26 publications

References 24 publications

Management of regional lymph nodes in the elderly melanoma patient: Patient selection, accuracy and prognostic implications

Management of regional lymph nodes in the elderly melanoma patient: Patient selection, accuracy and prognostic implications

Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes

Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma

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