Prognostic importance of lymph node tumor burden in melanoma patients staged by sentinel node biopsy

Ranieri, Jaime M.; Wagner, Jeffrey D.; Azuaje, Rafael; Davidson, Darrell D.; Wenck, Stacie; Fyffe, Joanne; Coleman, John J.

doi:10.1007/bf02574515

Cited by 97 publications

(49 citation statements)

References 12 publications

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“…The rates for positive CLNDs were not significantly different for SLN macrometastases and micrometastases. This is in accordance with other studies in which reproducible prediction of non-SLN positivity on the basis of SLN tumour burden remained elusive (Ranieri et al, 2002;Carlson et al, 2003;Pearlman et al, 2006;Roka et al, 2008). Additional positive non-SLNs upon CLND are widely recognised to adversely influence prognosis (Carlson et al, 2003).…”

Section: Discussionsupporting

confidence: 90%

“…Roka et al (2008) were able to partly confirm this: even though no significant association between SLN tumour load and non-SLN positivity was found, the rate of DFS for patients with an SLN tumour burden of 42 mm was significantly worse. Similar observations come from a study by Ranieri et al (2002), albeit with a cutoff at 3 mm. Our own data confirm these results in part: SLN tumour burden with a cutoff at 2 mm was indeed a significant prognosticator for tumour recurrence (P ¼ 0.005, log-rank test), with the rates of relapse during the median observation period more than twice as frequent for SLN macrometastases (51.3%) as for micrometastases (24.6%).…”

Section: Discussionsupporting

confidence: 84%

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The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

et al. 2008

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Twenty per cent of sentinel lymph node (SLN)-positive melanoma patients have positive non-SLN lymph nodes in completion lymph node dissection (CLND). We investigated SLN tumour load, non-sentinel positivity and disease-free survival (DFS) to assess whether certain patients could be spared CLND. Sentinel lymph node biopsy was performed on 392 patients between 1999 and 2005. Median observation period was 38.8 months. Sentinel lymph node tumour load did not predict non-SLN positivity: 30.8% of patients with SLN macrometastases (X2 mm) and 16.4% with micrometastases (p2 mm) had non-SLN positivity (P ¼ 0.09). Tumour recurrences after positive SLNs were more than twice as frequent for SLN macrometastases (51.3%) than for micrometastases (24.6%) (P ¼ 0.005). For patients with SLN micrometastases, the DFS analysis was worse (P ¼ 0.003) when comparing those with positive non-SLNs (60% recurrences) to those without (17.6% recurrences). This difference did not translate into significant differences in DFS: patients with SLN micrometastasis, either with (P ¼ 0.022) or without additional positive non-SLNs (Po0.0001), fared worse than patients with tumour-free SLNs. The 2-mm cutoff for SLN tumour load accurately predicts differences in DFS. Non-SLN positivity in CLND, however, cannot be predicted. Therefore, contrary to other studies, no recommendations concerning discontinuation of CLND based on SLN tumour load can be deduced.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 84%

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

et al. 2008

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“…11,29 The approach of using micrometric assessment of metastatic tumor diameter has been profitably developed by Starz et al, 30,31 in Augsburg, and alone or in combination with determination of the number of 1-mm-thick slices of the sentinel nodes that contain tumor applied to the evaluation of sentinel nodes. The use of ocular micrometers to evaluate the diameter of metastases in sentinel node has also been reported by Wagner et al, 32 and Ranieri et al 33 We are currently collaborating with the Augsburg group to compare the predictive value of area measurements of nodal tumor with the information obtainable by evaluation of the micrometer-measured maximum diameter nodal tumor. If the micrometer approach provides guidance comparable to the tumor predictive accuracy of tumor area assessment, it would be preferable as a relatively simple approach since the technique is already widely used in routine anatomic pathology evaluation.…”

Section: Discussionmentioning

confidence: 62%

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

et al. 2004

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Lymphatic mapping and sentinel node biopsy are well-established techniques for staging and managing patients with melanoma, breast cancer and other malignancies that spread initially to the regional lymph nodes. Identification of tumor in the sentinel node is the most precise staging technique currently available. The sentinel node is the site of metastatic melanoma in approximately 20% of melanoma patients and if tumor is present in the sentinel node it is customary to perform a complete dissection of the lymph nodes of the affected nodal basin. This may be overtreatment for some patients as tumor is identified in the nonsentinel nodes of only one-third of sentinel node-positive melanoma patients treated by completion lymphadenectomy. If it were possible accurately to identify the minority of patients with tumor in the nonsentinel nodes, the patients most likely to benefit from lymphadenectomy, the remaining patients could be spared a potentially morbid operation that is unlikely to confer clinical advantage. In 90 patients with a melanoma-positive sentinel node, who subsequently had a completion lymphadenectomy, we evaluated and compared the capacity of characteristics of the primary melanoma and of the sentinel node to predict individuals likely to have tumor in nonsentinel nodes. We assessed the Breslow thickness of the primary, the amount of tumor in the sentinel node (relative tumor area) and, as an index of immune modulation of the sentinel node, the density of dendritic leukocytes in the nodal paracortex. The relative area of tumor in the sentinel node and Breslow thickness of the primary melanoma most accurately predicted the presence of tumor in the nonsentinel nodes (P ¼ 0.0001 in both cases-Wilcoxon rank sums). The presence of melanoma in the nonsentinel nodes was also predicted by the density of dendritic leukocytes in the paracortex (P ¼ 0.008-Wilcoxon rank sums). These three observations assessed alone and in combination predict the presence of tumor in the nonsentinel nodes with high accuracy. The same characteristics also significantly correlated with tumor recurrence (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0.0007) and death from melanoma (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0. Keywords: melanoma; sentinel node; tumor burden; immune suppression; tumor recurrence; melanoma deathThe techniques of lymphatic mapping and sentinel node biopsy were developed to improve the management of patients with high-risk (thick and deep) primary melanoma with a high potential for metastases, but no clinical evidence of metastatic spread.

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“…In comparison with the high literature coverage of NSLN involvement predictive factors, few data are reported on this latter topic. Previous studies indicated that the dimensions of nodal tumour deposits could be significant predictors [37] and [38]. Roka et al [8] reported an SLN tumour size >2 mm, presence of NSLN involvement and Breslow thickness to be associated with different recurrence-free and disease-specific survival and confirmed the prognostic relevance of the S/U score proposed by Reeves et al [20] In another paper, the presence of micro-metastatic tumour deposits in SLN was associated to a significantly better prognosis with respect to macrometastases [9].…”

Section: Discussionmentioning

confidence: 99%

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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Prognostic importance of lymph node tumor burden in melanoma patients staged by sentinel node biopsy

Abstract: Microstaging of melanoma sentinel lymph node/CLND specimens by using the diameter of the largest tumor deposit is a highly significant predictor of early relapse and survival.

Cited by 97 publications

References 12 publications

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

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

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