Factors Predictive of Tumor-Positive Nonsentinel Lymph Nodes After Tumor-Positive Sentinel Lymph Node Dissection for Melanoma

Lee, Jonathan H.; Essner, Richard; Torisu‐Itakura, Hitoe; Wanek, Leslie A.; Wang, He-Jing; Morton, Donald L.

doi:10.1200/jco.2004.01.012

Cited by 150 publications

(93 citation statements)

References 36 publications

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“…In our experience, the number of positive SLNs was not associated to an increasing NSLN involvement, whilst the prognostic relevance of Starz classification was ascertained in univariate but not confirmed in multivariate logistic regression analysis. The predictive value of Breslow thickness on NSLN involvement has been found in some previous papers, but not confirmed by others [10], [13], [14], [15], [20], [31] and [33]; the same happens for ulceration, thus confirming a great deal of variability which limits the drawing of definite conclusions. Some studies suggested also to consider the association of two or more variables.…”

Section: Discussionmentioning

confidence: 89%

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

Quaglino

Ribero²,

Osella‐Abate

et al. 2011

Surgical Oncology

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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.

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Section: Discussionmentioning

confidence: 89%

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

Quaglino

Ribero²,

Osella‐Abate

et al. 2011

Surgical Oncology

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“…In a study conducted by Morton et al (2006), a 5-year survival rate of 72% was seen in patients with positive sentinel lymph nodes, followed by immediate lymph node dissection, whereas patients undergoing a delayed lymph node dissection had a 5-year survival rate of only 52%. However, further positive non-sentinel lymph nodes are found in a relatively small proportion of patients: previously quoted figures ranged from 17%-24% (Ghaferi et al, 2009;Lee et al, 2004;Rossi et al, 2008;Wright et al, 2010). However, a recent study has shown rates of further positive findings to be as low as 14.8% (Kunte et al, 2011).…”

Section: Elective Regional Lymph Node Dissectionmentioning

confidence: 82%

Current Controversies in the Surgical Management of Melanoma

Dp¹,

Prichard²,

Adk³

2011

Current Management of Malignant Melanoma

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“…This has prompted several authors to try to identify patients at low risk of harboring additional microscopically evident disease in the nonsentinel lymph nodes. 104,105 The experience of Wagner et al, as published in Cancer, has been representative; most investigators have had difficulty reliably predicting which patients may safely avoid a lymph node dissection. 106 These reports have cemented the completion lymph node dissection as the standard of care when a patient has a positive sentinel lymph node, at least for now.…”

Section: Surgical Treatment Of Melanomamentioning

confidence: 99%