Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma

Kruper, Laura; Spitz, Francis R.; Czerniecki, Brian J.; Fraker, Douglas L.; Blackwood‐Chirchir, Anne; Ming, Michael E.; Elder, David E.; Elenitsas, Rosalie; Guerry, DuPont; Gimotty, Phyllis A.

doi:10.1002/cncr.22295

Cited by 108 publications

(72 citation statements)

References 36 publications

(128 reference statements)

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“…Rousseau et al 38 found that Breslow thickness, ulceration, age ::;so years and truncal location were significant predictors of SN metastases. Other histopathological factors published by others such as mitotic index, 37 tumor infiltrating lymphocytes, 39 or angiolymphatic invasion 40 were also predictive of SN positivity. Our multivariate logistic regression analysis for predictive factors of SN metastases showed that only Breslow thickness was statistically significant (T3: p = 0.009, T4: p < 0.001).…”

Section: • 23mentioning

confidence: 65%

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Roulin

Matter

Bady

et al. 2008

European Journal of Surgical Oncology (EJSO)

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Aim: To confirm the accuracy of sentine! node biopsy (SNB) procedure and its morbidity, and to investigate predictive factors for SN status and prognostic factors for disease-free survival (DFS) and disease-specific survival (DSS). Materials and methods: Between October 1997 and December 2004, 327 consecutive patients in one centre with clinically node-negative primary skin melanoma underwent an SNB by the triple technique, i.e. lymphoscintigraphy, blue-dye and gamma-probe. Multivariate logistic regression analyses as well as the Kaplan-Meier were performed. Results: Twenty-three percent of the patients had at least one metastatic SN, which was significantly associated with Breslow thickness (p < 0.001). The success rate of SNB was 99.1 % and its morbidity was 7.6%. With a median follow-up of 33 months, the 5-year DFS/ DSS were 43%/49% for patients with positive SN and 83.5%/87.4% for patients with negative SN, respectively. The false-negative rate of SNB was 8.6% and sensitivity 91.4%. On multivariate analysis, DFS was significantly worsened by Breslow thickness (RR = 5.6, p < 0.001), positive SN (RR = 5.0, p < 0.001) and male sex (RR = 2.9, p = 0.001). The presence of a metastatic SN (RR = 8.4, p < 0.001), male sex (RR = 6.1,p < 0.001), Breslow thickness (RR = 3.2,p = 0.013) and ulceration (RR = 2.6,p = 0.015) were significantly associated with a poorer DSS. Conclusion: SNB is a reliable procedure with high sensitivity (91.4%) and low morbidity. Breslow thickness was the only statistically significant parameter predictive of SN status. DFS was worsened in decreasing order by Breslow thickness, metastatic SN and male gender. Similarly DSS was significantly worsened by a metastatic SN, male gender, Breslow thickness and ulceration. These data reinforce the SN status as a powerful staging procedure. © 2007 Elsevier Ltd. All rights reserved.Keywords: Melanoma; Sentine! lymph node; Prognostic factors; Survival Introduction Sentinel node biopsy (SNB) is an important staging procedure and may be a potential therapeutic approach in the management of melanoma. Metastatic spreading from a primary melanoma can be explained by two possible theories. 1 In the "marker" hypothesis, the primary melanoma metastasizes * Corresponding author. Tel.: +41 21 314 23 54; fax: +41 2131428 51. E-mail address: maurice.matter@chuv.ch (M. Matter).0748-7983/$ -see front malter © 2007 Elsevier Ltd. Ali rights reserved. doi: 10.1016Ali rights reserved. doi: 10. /j.ejso.2007 simultaneously via lymphatic and haematogenous routes, so that the presence of regional lymph nodes metastases becomes a marker of the likelihood of systemic disease. In the "incubator" hypothesis, the primary melanoma targets regional lymph nodes where metastatic cells may survive and slowly grow but remain latent before spreading to distant sites. According to this second theory, it was suggested that early removal of involved regional lymph nodes in earlyand intermediate-stage melanoma could prevent the progression of the metastases and thus improve survival...

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Section: • 23mentioning

confidence: 65%

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Roulin

Matter

Bady

et al. 2008

European Journal of Surgical Oncology (EJSO)

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“…More recently, cellular proliferation within the primary tumor, as reflected by its mitotic rate, has emerged as another important predictive factor for survival. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Indeed, Azzola et al 4 reported that mitotic rate was a more powerful prognostic indicator than ulceration in a 3,661-patient, single-institution series. More recently, detailed analysis of primary tumor mitotic rate data recorded in the American Joint Committee on Cancer (AJCC) Melanoma Staging Database, which contains information from multiple institutions and cancer cooperative groups, has confirmed previous reports that there is a significant correlation between increasing mitotic rate and a declining survival probability.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Mitotic Rate in Localized Primary Cutaneous Melanoma: An Analysis of Patients in the Multi-Institutional American Joint Committee on Cancer Melanoma Staging Database

Thompson

Soong

Balch

et al. 2011

JCO

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314

213

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A B S T R A C T PurposeThe aim of this study was to assess the independent prognostic value of primary tumor mitotic rate compared with other clinical and pathologic features of stages I and II melanoma. MethodsFrom the American Joint Committee on Cancer (AJCC) melanoma staging database, information was extracted for 13,296 patients with stages I and II disease who had mitotic rate data available. ResultsSurvival times declined as mitotic rate increased. Ten-year survival ranged from 93% for patients whose tumors had 0 mitosis/mm 2 to 48% for those with Ն 20/mm 2 (P Ͻ .001). Mean number of mitoses/mm 2 increased as the primary melanomas became thicker (1.0 for melanomas Յ 1 mm, 3.5 for 1.01 to 2.0 mm, 7.3 for 3.01 to 4.0 mm, and 9.6 for Ͼ 8 mm). Ulceration was also associated with a higher mitotic rate; 59% of ulcerated melanomas had Ն 5 mitoses/mm 2 compared with 16% of nonulcerated melanomas (P Ͻ .001). In a multivariate analysis of 10,233 patients, the independent predictive factors for survival in order of statistical significance were as follows: tumor thickness ( 2 ϭ 104.9; P Ͻ .001), mitotic rate ( 2 ϭ 67.0; P Ͻ .001), patient age ( 2 ϭ 48.2; P Ͻ .001), ulceration ( 2 ϭ 46.4; P Ͻ .001), anatomic site ( 2 ϭ 34.6; P Ͻ .001), and patient sex ( 2 ϭ 33.9; P Ͻ .001). Clark level of invasion was not an independent predictor of survival ( 2 ϭ 3.2; P ϭ .37). ConclusionA high mitotic rate in a primary melanoma is associated with a lower survival probability. Among the independent predictors of melanoma-specific survival, mitotic rate was the strongest prognostic factor after tumor thickness.

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“…In contrast, some authors showed that the presence of regression in primary melanomas was not associated with lymph node metastasis. 2,86,[88][89][90][91][92][93][94][95][96][97] Some studies have demonstrated a lack of correlation between extent of regression and SLN status. 2,4,7,76,82 Yet other studies have reported that the presence of regression may be associated with negative SLN status.…”

Section: Association Between Regression and Recurrencementioning

confidence: 99%

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists' interpretation. Regression is histologically characterized by variable decrease in the number of melanoma cells accompanied by the presence of a host response consisting of dermal fibrosis, inflammatory infiltrate, melanophages, ectatic blood vessels, epidermal attenuation, and/or apoptosis of keratinocytes or melanocytes; the relative extent of these features depends on the stage of the regression. However, the magnitudes to which these individual changes must be present to meet the threshold of histologic regression have not been well defined or agreed upon, and thus, the definition and classification of histologic regression in melanoma varies considerably among institutions and even among individual pathologists. In order to determine the clinical significance of histologic analysis of regression, there is a compelling need for a universal scheme to objectively define and assess histologic regression in primary cutaneous melanoma, so that the biologic and prognostic significance of this process may be completely understood.

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Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma

Cited by 108 publications

References 36 publications

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Prognostic Significance of Mitotic Rate in Localized Primary Cutaneous Melanoma: An Analysis of Patients in the Multi-Institutional American Joint Committee on Cancer Melanoma Staging Database

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

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