Prognostic Role of Multiple Lymphatic Basin Drainage in Sentinel Lymph Node-Negative Trunk Melanoma Patients: A Multicenter Study from the Italian Melanoma Intergroup

Ribero, Simone; Osella‐Abate, Simona; Pasquali, Sandro; Róssi, Carlo; Borgognoni, Lorenzo; Piazzalunga, Dario; Solari, Nicola; Schiavon, Maurizio; Brandani, Paola; Ansaloni, Luca; Ponte, E; Silan, Francesco; Sommariva, Antonio; Bellucci, Francesco; Macripò, Giuseppe; Quaglino, Pietro

doi:10.1245/s10434-015-4973-6

Cited by 11 publications

(13 citation statements)

References 38 publications

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“…Also in our study, the worse 5-year MSS was also seen in CLND-positive patients compared to CLND-negative patients. Positive SNs in two basins has been published to be worse prognostic factor [19,20]. In our study, only six patients had positive SN in two basins.…”

Section: Discussioncontrasting

confidence: 42%

Sentinel node tumor burden in prediction of prognosis in melanoma patients

Palve

Ylitalo

Luukkaala

et al. 2020

Clin Exp Metastasis

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Recent data have demonstrated no survival benefit to immediate completion lymph node dissection (CLND) for positive sentinel node (SN) disease in melanoma. It is important to identify parameters in positive SNs, which predict prognosis in melanoma patients. These might provide prognostic value in staging systems and risk models by guiding high-risk patients' adjuvant therapy in clinical practice. In this retrospective study of university hospital melanoma database we analyzed tumor burden and prognosis in patients with positive SNs. Patients were stratified by the diameter of tumor deposit, distribution of metastatic focus in SN, ulceration and number of metastatic SNs. These were incorporated in Cox proportional hazard regression models. Predictive ability was assessed using Akaike information criterion and Harrell's concordance index. A total of 110 patients had positive SN and 104 underwent CLND. Twenty-two (21%) patients had non-SN metastatic disease on CLND. The 5-year melanoma specific survival for CLND-negative patients was 5.00 years (IQR 3.23-5.00, range 0.72-5.00) compared to 3.69 (IQR 2.28-4.72, range 1.01-5.00) years in CLND-positive patients (HR 2.82 (95% CI 1.17-6.76, p = 0.020).The models incorporating distribution of metastatic focus and the largest tumor deposit in SN had highest predictive ability. According to Cox proportional hazard regression models, information criterions and c-index, the diameter of tumor deposit > 4 mm with multifocal location in SN despite of number of metastatic SN were the most important parameters. According to the diameter of tumor deposit and distribution of metastatic focus in SN, adequate stratification of positive SN patients was possible and risk classes for patients were identified.

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Section: Discussioncontrasting

confidence: 42%

Sentinel node tumor burden in prediction of prognosis in melanoma patients

Palve

Ylitalo

Luukkaala

et al. 2020

Clin Exp Metastasis

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“…Guidelines for follow-up of stage I–II patients (correctly staged through SLNB or not) differ around centres and usually do not envisage serial screening of visceral sites in the low risk of progression group [10,11] although many patients with an intermediate Breslow thickness melanoma risk progress directly to a visceral site [6,12]. In stage IB/II patients, a more individualised follow-up taking into account the risk factors associated with relapse in visceral sites, which include male gender, trunk site and different SLNB proposal and management [6,7,13,14,15,16], would be desirable.…”

Section: Discussionmentioning

confidence: 99%

TERT Promoter Mutations are Associated with Visceral Spreading in Melanoma of the Trunk

Osella‐Abate

Bertero

Senetta

et al. 2019

Cancers

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Survival predictions are currently determined on the basis of NRAS/BRAF mutations, even though TERT promoter mutations have been recently associated with a poor prognosis in stage I-II melanomas. Usually, it is not recommended to perform a mutational test on primary melanoma, as the results do not always reflect the mutational status of metastases. In particular, trunk melanomas have been reported to have an unfavourable prognosis. A series of 105 advanced melanoma patients were analysed by TERT promoter Sanger sequencing. Univariate/multivariate binary logistic regression models were performed using progression to a visceral site as the dependent variable and patient/tumour characteristics as covariates. Performance of the model was assessed in an external independent primary melanoma patients’ dataset. Male gender (odds ratio (OR), 344; 95% CI, 1.12–10.6; p = 0.031), AJCC (American Joint Committee on Cancer) classification (OR, 022; 95% CI, 0.07–0.67; p = 0.008), SLNB (Sentinel Lymph Node Biopsy) status (OR, 3.05; 95% CI, 1.06–8.78; p = 0.039) and TERT-mutated trunk lesions (OR, 3.78; 95% CI, 1.35–10.6; p = 0.011) were significantly associated with the risk of developing a visceral spreading as first site of progression using multivariate logistic regression analysis. These results were confirmed in the external validation control group. Therefore, in trunk primary melanomas, due to their high risk of progression to visceral sites, we encourage somatic TERT mutation analysis at diagnosis to identify those patients who would potentially benefit from a more intensive follow-up protocol and a prompt initiation of therapy.

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“…Reported data regarding the prognostic role of histological regression have hitherto been conflicting . A recent paper on a large cohort of stage I–II patients showed a protective role on prognosis in patients with melanoma with histological regression (American Joint Committee on Cancer stage I–II) .…”

Section: Discussionmentioning

confidence: 99%

“…Reported data regarding the prognostic role of histological regression have hitherto been conflicting. 5,[25][26][27] A recent paper on a large cohort of stage I-II patients showed a protective role on prognosis in patients with melanoma with histological regression (American Joint Committee on Cancer stage I-II). 23 At the same time, the discussion regarding SLN performance in thin melanoma with regression has been brought to a conclusion: 28 a meta-analysis has confirmed that histological regression is not a criterion for recommendation of SLN biopsy in thin melanomas.…”

Section: Discussionmentioning

confidence: 99%

Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis

et al. 2017

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Summary The prognostic significance of histological regression in primary melanoma has been debated for many years. We aim to review the evidence to see how histological regression may affect prognosis. A systematic review was performed by searching in MEDLINE, Scopus and the Cochrane Library from 1 January 1966 to 1 August 2015. All studies reporting hazard ratios or data on survival and histological regression were included. Primary random‐effects meta‐analyses were used to summarize outcome measures. Heterogeneity was assessed using the χ2‐test and I2‐statistic. To assess the potential bias of small studies we used funnel plots and the Begg and Mazumdar adjusted rank correlation method. Summaries of survival outcomes were measured as hazard ratios or relative risk of death at 5 years according to the presence of histological regression of primary melanoma. In total, 183 articles were reviewed out of 1876 retrieved. Ten studies comprising 8557 patients were included. Patients with histological regression had a lower relative risk of death (0·77, 95% confidence interval 0·61–0·97) than those without. Examination of the funnel plot did not provide evidence of publication bias. The results showed that histological regression is a protective factor for survival.

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Prognostic Role of Multiple Lymphatic Basin Drainage in Sentinel Lymph Node-Negative Trunk Melanoma Patients: A Multicenter Study from the Italian Melanoma Intergroup

Abstract: Patients with negative SLN biopsy results have better prognosis when two or more lymphatic basins are identified and analyzed. Further research is required to investigate the mechanisms behind this evidence.

Cited by 11 publications

References 38 publications

Sentinel node tumor burden in prediction of prognosis in melanoma patients

Sentinel node tumor burden in prediction of prognosis in melanoma patients

TERT Promoter Mutations are Associated with Visceral Spreading in Melanoma of the Trunk

Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis

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