Relationship of patient age to tumor factors and outcomes among patients undergoing sentinel node biopsy for melanoma

Radu, Stephanie; Han, Dale; Fowler, Graham; Han, Gang; Fortino, Jeanine; Vetto, John T.

doi:10.1016/j.amjsurg.2020.03.013

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…Furthermore, increasing TIL levels were correlated with a decreasing positive SLN rate, with the lowest SLN metastasis rate found in patients with B TILs. In addition, this study confirms prior studies reporting the predictive value of age, gender, thickness, ulceration, LVI, MS, and primary site in predicting SLN positivity 26‐32 . In light of the strong association between TIL status and SLN status, TIL status may potentially be considered when patients are being selected for SLNB because patients with A TILs may be at higher risk for SLN metastases, whereas patients with thinner melanomas that have B TILs may have a lower risk for SLN disease; however, this would need further evaluation.…”

Section: Discussionsupporting

confidence: 82%

Is the presence of tumor‐infiltrating lymphocytes predictive of outcomes in patients with melanoma?

Morrison

Han

Elenwa

et al. 2022

Cancer

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Background The significance of tumor‐infiltrating lymphocytes (TILs) in melanoma is debated. This article presents a multicenter, retrospective study assessing the predictive and prognostic value of TILs. Methods The Sentinel Lymph Node Working Group database was queried from 1993 to 2018 for cases with known TIL data. TILs were categorized as absent or present, which included nonbrisk (NB), brisk (B), and present but unspecified TIL levels. Clinicopathologic factors were correlated with TILs, sentinel lymph node (SLN) status, and melanoma‐specific survival (MSS). Results Overall, 3203 patients were included. The median thickness was 1.5 mm, and 469 cases had SLN metastases. TILs were present in 2458 cases (76.7%), with NB, B, and unspecified TILs seen in 1691 (68.8%), 691 (28.1%), and 76 (3.1%), respectively. Multivariable analysis showed that the presence of TILs significantly predicted a negative SLN biopsy (P < .05). The median follow‐up was 25.2 months. MSS was significantly better for cases with TILs than cases without TILs (P < .001). According to multivariable analysis, age, gender, thickness, mitotic rate, ulceration, lymphovascular invasion, and SLN status were significantly prognostic of MSS (all P values < .05). Although TILs were not prognostic of MSS, when multiple imputation was used and the SLN status was excluded, the presence of TILs was significantly prognostic of improved MSS (hazard ratio, 0.78; 95% confidence interval, 0.64‐0.95; P = .0154). Conclusions TILs are a favorable marker because their presence significantly predicts a negative SLN, and the absence of TILs may be a prognostic marker of worse survival in patients with a positive SLN but not a negative SLN. TILs may also serve as a prognostic marker of survival when the SLN status is not considered.

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Section: Discussionsupporting

confidence: 82%

Is the presence of tumor‐infiltrating lymphocytes predictive of outcomes in patients with melanoma?

Morrison

Han

Elenwa

et al. 2022

Cancer

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“…Similarly, Huayllani et al 20 reviewed 26,440 patients with cutaneous melanoma from the National Cancer Database and found that along with head and neck location, older patient age was associated with residual tumor in margins for Breslow depth groups ≤1 mm and >2 mm. Radu et al 21 reviewed 1633 patients and found that compared with patients age less than 30 years, older age greater than 60 years was directly associated with higher frequency of male sex, head and neck tumor location, all-site tumor relapse, metastasis, and melanoma-related death. Additional considerations contributing to worse outcomes for older patients include differences in the immune response, prevalence of comorbidities, and limited access to care for older adults, as well as the possibility of less aggressive surgical approach because of coexisting health problems or more prevalent head and neck tumor location where large excision requires reconstruction with a specialist.…”

Section: Discussionmentioning

confidence: 99%

“…reviewed 26,440 patients with cutaneous melanoma from the National Cancer Database and found that along with head and neck location, older patient age was associated with residual tumor in margins for Breslow depth groups #1 mm and .2 mm. Radu et al21 reviewed 1633 patients and found that compared with patients age less than 30 years, older age greater than 60…”

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confidence: 99%

Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center

Dalvin

Yaghy

Vaidya

et al. 2020

Cornea

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To investigate the clinical features and outcomes for conjunctival melanoma based on patient age. Methods: A retrospective review of patients with conjunctival melanoma managed at a single tertiary referral center from April 18, 1974, to September 9, 2019. Clinical features and outcomes were compared by patient age category at presentation (young #45 years, middle-aged 46-69 years, and older $70 years), with Kaplan-Meier and Cox proportional hazard analysis [hazard ratio (95% confidence interval)].Results: There were 629 patients categorized as young in 130 (21%), middle-aged in 278 (44%), and older in 221 (35%). A comparison by age category (young vs. middle-aged vs. older) revealed that older patients had melanoma with greater number of affected quadrants (1.7 vs. 1.8 vs. 2.0, P = 0.001) and clock hours (3.9 vs. 4.2 vs. 5.2, P = 0.001). All patients were treated with surgical excision, with no difference in requirement for additional medical or radiation therapy. By 10-year Kaplan-Meier outcomes, older patients had more frequent visual acuity loss $3 lines (11% vs. 28% vs. 64%, P , 0.001) and local tumor recurrence (38% vs. 46% vs. 70%, P , 0.001). Hazard ratio for the oldest age group (age $70) revealed a 7.76-fold (3.33-18.09) increased risk for visual acuity loss (P , 0.001), and a 2. 08-fold (1.32-3.28) increased risk of local tumor recurrence (P = 0.002). There was no difference by age in risk for enucleation, exenteration, locoregional lymph node involvement, distant systemic metastasis, or death. Conclusions:Older patients with conjunctival melanoma present with more extensive disease and have increased risk for visual acuity loss and local tumor recurrence.

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“…Moreover, the surgical anatomy of the neck is challenging, and, in the case of the parotid gland where 70% of head and neck SCCs drain, its relationship with facial and accessory nerves requires a thorough analysis of the risk-benefit balance. The literature on SLNB in patients with melanoma has also shown that increasing age is related to lower SLNB positivity rates, slower lymphatic drainage, and greater surgical risk related to the poorer performance status of elderly patients [31,33].…”

Section: Surgical Management Of Lymph Node Metastasis Of Csccmentioning

confidence: 99%

Surgery for Cutaneous Squamous Cell Carcinoma and its Limits in Advanced Disease

Moreno‐Ramírez

Silva-Clavería

Fernández‐Orland

et al. 2021

Dermatol Pract Concept

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Surgery remains the first-line therapeutic option for most patients with cutaneous squamous cell carcinoma (cSCC). However, in the current therapeutic landscape, surgery must attempt to the complete tumor resection (R0 resection) with the lowest risk of surgical complications. This double aim is usually accomplished through standard excision with clinical margins in patients with low-risk tumors or by some of the micrographically controlled surgery procedures for patients with tumors at high-risk of local recurrence and metastasis. Surgery is also a first-line treatment for nodal metastases of cSCC as well as an option to consider in patients who develop recurrences while receiving immunotherapy, or as a palliation procedure in patients with advanced tumors. Neoadjuvant immunotherapy, that is the use of a medical treatment before surgery, is under investigation in patients with cSCC. The decision-making process and guidelines recommendations regarding cSCC surgery are reviewed in this manuscript.

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Relationship of patient age to tumor factors and outcomes among patients undergoing sentinel node biopsy for melanoma

Cited by 5 publications

References 21 publications

Is the presence of tumor‐infiltrating lymphocytes predictive of outcomes in patients with melanoma?

Is the presence of tumor‐infiltrating lymphocytes predictive of outcomes in patients with melanoma?

Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center

Surgery for Cutaneous Squamous Cell Carcinoma and its Limits in Advanced Disease

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