Prognostic factors associated with sentinel lymph node positivity and effect of sentinel status on survival: an analysis of 1049 patients with cutaneous melanoma

Kunte, Christian; Geimer, Till; Baumert, Jens; Konz, Birger; Volkenandt, Matthias; Flaig, Michael J.; Ruzicka, Thomas; Berking, Carola; Schmid‐Wendtner, Monika‐Hildegard

doi:10.1097/cmr.0b013e32833ba9ff

Cited by 59 publications

(64 citation statements)

References 36 publications

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“…In the presence of primary tumor ulceration, the sentinel lymph node was significantly more often positive than in the absence of ulceration [144,146,148,157].…”

Section: R Gutzmermentioning

confidence: 95%

“…Regression of the primary tumor either has not been correlated with sentinel lymph node positivity [144,165,166] or it has been correlated with lower sentinel lymph node positivity [148,167]. Primary tumor location plays no role in the indication for SLNB.…”

Section: R Gutzmermentioning

confidence: 99%

“…In particular, younger patients < 40 years with a tumor thickness of 0.75-1 mm frequently (19.5 %) showed a positive sentinel lymph node [158]. 159/632 patients (25.2 %) with a tumor thickness between 1 and 4 mm displayed a positive sentinel lymph node [144], and even within subgroups of this 1-4 mm range, the rate in positive sentinel lymph nodes increased with rising tumor thickness. Between 1-1.59 mm, 66/762 patients were positive (8.7 %) and between 1.6-2 mm 67/348 patients (19.3 %) [145].…”

Section: R Gutzmermentioning

confidence: 99%

“…Tumor thickness > 4 mm resulted in a positive SLN in 43/75 patients (57.3 %, [144]), respectively 74/152 (48.5 %) [159] and 100/240 (41.7 %) [160].…”

Section: R Gutzmermentioning

confidence: 99%

“…Systematic search of the literature de-novo: [144][145][146][147][148][149][150] Strength of consensus: 100 %…”

Section: Level Of Evidence 1amentioning

confidence: 99%

See 4 more Smart Citations

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

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

180

148

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“…In the presence of primary tumor ulceration, the sentinel lymph node was significantly more often positive than in the absence of ulceration [144,146,148,157].…”

Section: R Gutzmermentioning

confidence: 95%

Section: R Gutzmermentioning

confidence: 99%

Section: R Gutzmermentioning

confidence: 99%

“…Tumor thickness > 4 mm resulted in a positive SLN in 43/75 patients (57.3 %, [144]), respectively 74/152 (48.5 %) [159] and 100/240 (41.7 %) [160].…”

Section: R Gutzmermentioning

confidence: 99%

“…Systematic search of the literature de-novo: [144][145][146][147][148][149][150] Strength of consensus: 100 %…”

Section: Level Of Evidence 1amentioning

confidence: 99%

See 3 more Smart Citations

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

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

180

148

View full text Add to dashboard Cite

Prediction of Sentinel Lymph Node Positivity by Growth Rate of Cutaneous Melanoma

Tejera‐Vaquerizo

Nagore²,

Herrera‐Acosta³

et al. 2012

Arch Dermatol

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Main Outcome Measure: Based on previous studies, a surrogate measure for GR in primary invasive melanoma was calculated as the ratio of Breslow thickness to time to melanoma development. Results: The SLN was positive in 20.2% of patients. Multivariate logistic regression analysis revealed that GR, Bres-low thickness, and the presence of microscopic satellitosis were independently associated with SLN positivity. The probability of SLN positivity was 8.2% for slowgrowth melanomas (Ͻ0.10 mm/mo) compared with 19.8% for intermediate-growth melanomas (0.10-0.50 mm/mo) and 37.7% for fast-growth melanomas (Ͼ0.50 mm/mo). Growth rate was not an independent predictive factor for survival. Conclusion: Growth rate of primary cutaneous melanoma, together with Breslow thickness and the presence of microscopic satellitosis, predicts the histological SLN positivity.

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Association Between Patient Age and Lymph Node Positivity in Thin Melanoma

et al. 2017

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IMPORTANCE More than half of all new melanoma diagnoses present as clinically localized T1 melanoma, yet sentinel lymph node biopsy (SLNB) is controversial in this population given the overall low yield. Guidelines for SLNB have focused on pathologic factors, but patient factors, such as age, are not routinely considered.OBJECTIVES To identify indicators of lymph node (LN) metastasis in thin melanoma in a large, generalizable data set and to evaluate the association between patient age and LN positivity. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study using the National Cancer Database, an oncology database representing patients from more than 1500 hospitals throughout the United States, was performed (2010)(2011)(2012)(2013). Data analysis was conducted from October 1, 2016, to January 15, 2017. A total of 8772 patients with clinical stage I 0.50 to 1.0 mm thin melanoma undergoing wide excision and surgical evaluation of regional LNs were included for study. MAIN OUTCOME AND MEASURESThe primary outcome of interest was presence of melanoma in a biopsied regional LN. Clinicopathologic factors associated with LN positivity were characterized, using logistic regression. Age was categorized as younger than 40 years, 40 to 64 years, and 65 years or older for multivariable analysis. Classification tree analysis was performed to identify high-risk groups for LN positivity.RESULTS Among the study cohort (n = 8772), 333 patients had nodal metastases, for an overall positivity rate of 3.8% (95% CI, 3.4%-4.2%). A total of 4087 (54.0%) patients were women. Median age was 56 years (interquartile range [IQR], 46-67) in patients with negative LNs and 52 years (IQR, 41-61) in those with positive LNs (P < .001). In multivariable analysis, younger age, female sex, thickness of 0.76 mm or larger, increasing Clark level, mitoses, ulceration, and lymphovascular invasion were independently associated with LN positivity. In decision tree analysis, patient age was identified as an important risk stratifier for LN metastases, after mitoses and thickness. Patients younger than 40 years with category T1b tumors 0.50 to 0.75 mm, who would generally not be recommended for SLNB, had an LN positivity rate of 5.6% (95% CI, 3.3%-8.6%); conversely, patients 65 years or older with T1b tumors 0.76 mm or larger, who would generally be recommended for SLNB, had an LN positivity rate of only 3.9% (95% CI, 2.7%-5.3%). CONCLUSIONS AND RELEVANCEPatient age is an important factor in estimating lymph node positivity in thin melanoma independent of traditional pathologic factors. Age therefore should be taken into consideration when selecting patients for nodal biopsy.

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Prognostic factors associated with sentinel lymph node positivity and effect of sentinel status on survival: an analysis of 1049 patients with cutaneous melanoma

Cited by 59 publications

References 36 publications

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

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

Prediction of Sentinel Lymph Node Positivity by Growth Rate of Cutaneous Melanoma

Association Between Patient Age and Lymph Node Positivity in Thin Melanoma

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