Predictive factors for sentinel lymph nodes and non-sentinel lymph nodes metastatic involvement: a database study of 1,041 melanoma patients

Kibrité, Antoine; Milot, Héléne; Douville, Pierre; Gagné, Éric; Labonté, Sebastien; Friede, Juan; Morin, Fannie; Ouellet, Jean-François; Claveau, Joël

doi:10.1016/j.amjsurg.2015.05.016

Cited by 22 publications

(13 citation statements)

References 19 publications

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“…The ability to predict the presence of non‐SLN disease could be useful in determining which patients may benefit from adjuvant therapy, as well as help guide the shared decision discussion between the patient and surgeon with regard to CLND. Several centres have studied non‐SLN prediction. The largest series to date was published by the Italian Melanoma Intergroup, which created a nomogram for the prediction of non‐SLN status in patients with SLN‐positive melanoma; this could be used as a clinical decision aid.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of completion lymph node dissection in sentinel lymph node-positive melanoma

Angeles

Kang

Shirai

et al. 2019

British Journal of Surgery

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Background: The role of completion lymph node dissection (CLND) in patients with sentinel lymph node (SLN)-positive melanoma continues to be debated. This systematic review and meta-analysis evaluated survival and recurrence rate in these patients who underwent CLND, compared with observation.Methods: A comprehensive MEDLINE and Embase database search was performed for cohort studies and RCTs published between January 2000 and June 2017 that assessed the outcomes of CLND compared with observation in patients with SLN-positive melanoma. The primary outcome was survival and the secondary outcome was recurrence rate. Studies were assessed for quality using the Cochrane risk-of-bias tool for RCTs and Newcastle-Ottawa Scale for cohort studies. Pooled relative risk or hazard ratio with 95 per cent confidence intervals were calculated for each outcome. The extent of heterogeneity between studies was assessed with the I 2 test. The protocol was registered in PROSPERO (CRD42017070152).Results: Fifteen studies (13 cohort studies with 7868 patients and 2 RCTs with 2228 patients) were identified for qualitative synthesis. Thirteen studies remained for quantitative meta-analysis. Survival was similar in patients who underwent CLND and those who were observed (risk ratio (RR) for death 0⋅85, 95 per cent c.i. 0⋅71 to 1⋅02). The recurrence rate was also similar (RR 0⋅91, 0⋅79 to 1⋅05).Conclusion: Patients with SLN-positive melanoma do not have a significant benefit in survival or recurrence rate if they undergo CLND rather than observation.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of completion lymph node dissection in sentinel lymph node-positive melanoma

Angeles

Kang

Shirai

et al. 2019

British Journal of Surgery

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“…Two studies found good to excellent interobserver reproducibility when analyzing pT1 melanomas and primary melanomas of all stages (pT1–pT4), while a recent study found unsatisfactory inter‐ and intraobserver reproducibility when looking at pT1 and pT2 melanomas . Similarly, the general prognostic value of the MR in primary melanomas has been demonstrated in several studies, while others were unable to provide statistical evidence that a MR >0 in a thin primary melanoma is significantly correlated with an increased risk of a positive SN …”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, the utility of the MR and its impact on treatment decisions should be assessed in each setting independently as the general prognostic value of the MR in primary melanomas of all stages and also its value in the assessment of atypical melanocytic tumors has been demonstrated in several studies.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies found good to excellent interobserver reproducibility when analyzing pT1 melanomas 21 and primary melanomas of all stages (pT1-pT4), 22 while a recent study found unsatisfactory inter-and intraobserver reproducibility when looking at pT1 and pT2 melanomas. 23 Similarly, the general prognostic value of the MR in primary melanomas [24][25][26][27] has been demonstrated in several studies, while others were unable to provide statistical evidence that a MR >0 in a thin primary melanoma is significantly correlated with an increased risk of a positive SN. 24,25,27 Nonetheless, the utility of the MR and its impact on treatment decisions should be assessed in each setting independently as the general prognostic value of the MR in primary melanomas of all stages [24][25][26][27] and also its value in the assessment of atypical melanocytic tumors 28,29 has been demonstrated in several studies.…”

Section: Cancer Therapy and Preventionmentioning

confidence: 99%

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Sentinel node metastasis mitotic rate (SN‐MMR) as a prognostic indicator of rapidly progressing disease in patients with sentinel node‐positive melanomas

Baum

Weiß

Gebhardt

et al. 2017

Intl Journal of Cancer

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Risk stratification of sentinel lymph node biopsy (SNB)-positive patients with malignant melanoma differs among current classification systems. To improve classification of patients with rapidly progressive disease who may profit from adjuvant therapy with novel immune or targeted treatment modalities, a single-center retrospective analysis was performed including all melanoma patients diagnosed with a positive SN at a university-based skin cancer center over a 10-year period (2002-2012) (96 of 419 patients). Sentinel node metastasis mitotic rate (SN-MMR) and further histologic parameters were determined by blinded histological re-evaluation and correlated with clinical follow-up (overall [OS], melanoma-specific [MSS], and disease-free survival [DFS]). Median follow-up was 53 months. In univariate analyses, SN tumor penetrative depth (TPD), maximum tumor diameter (MTD), number of positive SN, SN-MMR and the S-, Rotterdam, RDC, Hannover I and II classification systems correlated with OS, MSS and DFS. Multivariate Cox regression analyses showed that a binary classification system based only on the SN-MMR (<1 vs. ≥1 mitoses/mm ) was the strongest independent prognostic indicator for all endpoints analyzed. Kaplan-Meier analyses confirmed binary SN-MMR to be superior to stratify patients into high- and low-risk groups (45.45% vs. 87.92% 5-yr MSS). The general prognostic validity of the published SN classification systems was confirmed. The novel SN-MMR classification system may improve discrimination of patients with slowly and rapidly progressive disease. We therefore propose its implementation into clinical practice as the SN-MMR can be easily and reliably determined in routine pathology reports. Its prognostic value for the selection of patients amenable to adjuvant therapies should be studied in clinical trials.

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“…Azoknál a betegeknél, akiknél pozitív SLN került eltávolításra, a publikált közlemények eredményei szerint az elvégzett blokkdisszekcióval hozzávetőlegesen 20%-ban észleltek további pozitív nyirokcsomót. Azok a faktorok, amelyek a leginkább előrejelzik a további nyirokcsomó pozitivitást, a következők: a SLN legnagyobb mérete, az érintett sentinel nyirokcsomók száma, a metasztázis elhelyezkedése/megjelenése a nyirokcsomón belül (subscapuláris, vagy parenchymalis), és a primer tumor jellemzői, mint vastagság, ulceráció (32,56,(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75).…”

Section: A Blokkdisszekció Prognosztikai Jelentősége éS Terápiás Hasznaunclassified

Progress in the surgical treatment of cutaneous melanoma

Kis¹,

Kádár²,

Juhász³

2017

BVSZ

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A melanoma malignum kezelésében a korábbi mechanikus szemléletet felváltotta az ún. biológiai szemlélet, melynek során a szervezet tumorellenes mechanizmusait igyek szünk támogatni. Ez a szemléletváltás a melanoma sebészeti kezelésben a primer tumor körüli biztonsági zóna lecsökkentéséhez és az őrszem (sentinel) nyirokcsomó biopszia bevezetéséhez vezetett. A melanoma terápiájában manapság a sebészre négy meghatározó feladat hárul: a primer tumor eltávolítása, sentinel nyirokcsomó biopszia valamint blokkdisszekció elvégzése és a bőrmetasztázisok sebészi ellátása. Jelen összefoglaló közleményben a szerzők a legfrissebb nemzetközi irányelvek, tudományos eredmények és saját gyakorlatuk alapján részletes áttekintést nyújtanak a melanoma műtéti ellátásáról, beszámolnak a nem rezekábilis bőráttétek kezelésében hasz nálatos új eljárásról, a hazánkban is elérhető elektrokemoterápiáról. Kulcsszavak: melanoma malignum-biztonsági zónasentinel nyirokcsomó-blokkdisszekció-elektrokemoterápia SUMMARY Recently the biological approach dominates in the treatment of malignant melanoma, which means the support of the antitumor defense of the organism. This view has led to diminished safety margins at the removal of the primary tumor and introduction of sentinel lymph node biopsy. Nowadays surgeons have four main tasks in the treatment of melanoma: excision of primary tumor, sentinel lymph node biopsy, regional lymph node dissection, and surgical treatment of the metastases. Based on the latest international guidelines, published data, and best practices authors summarize the current surgical therapies of cutaneous malignant melanoma, and also account on electrochemotherapy, which is a new, effective treatment of the irresecable cutaneous metastases.

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Predictive factors for sentinel lymph nodes and non-sentinel lymph nodes metastatic involvement: a database study of 1,041 melanoma patients

Cited by 22 publications

References 19 publications

Meta-analysis of completion lymph node dissection in sentinel lymph node-positive melanoma

Meta-analysis of completion lymph node dissection in sentinel lymph node-positive melanoma

Sentinel node metastasis mitotic rate (SN‐MMR) as a prognostic indicator of rapidly progressing disease in patients with sentinel node‐positive melanomas

Progress in the surgical treatment of cutaneous melanoma

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