Skip to main content
Top
Published in: Clinical & Experimental Metastasis 5-6/2018

01-08-2018 | Research Paper

Lymph node metastasis in melanoma: a debate on the significance of nodal metastases, conditional survival analysis and clinical trials

Authors: Mark B. Faries, Dale Han, Michael Reintgen, Lauren Kerivan, Douglas Reintgen, Corrado Caracò

Published in: Clinical & Experimental Metastasis | Issue 5-6/2018

Login to get access

Abstract

While there is no doubt that regional lymph node metastases are an enormously important factor in melanoma staging and treatment, the biology behind this significance and its precise implications for treatment planning have been a leading controversy in melanoma and other solid tumors for over a century. Recent clinical data, including data from prospective randomized clinical trials have refined our understanding of the process of nodal metastases and the advantages and disadvantages of different clinical management strategies. This review presents two points of view in this debate and discusses the results of new data analyses as well as pivotal clinical trials informing the discussion.
Literature
2.
go back to reference Bodenham DC (1968) A study of 650 observed malignant melanomas in the South-West region. Ann R Coll Surg Engl 43:218–239PubMedPubMedCentral Bodenham DC (1968) A study of 650 observed malignant melanomas in the South-West region. Ann R Coll Surg Engl 43:218–239PubMedPubMedCentral
4.
go back to reference Fisher B, Fisher ER (1966) Transmigration of lymph nodes by tumor cells. Science 152:1397–1398CrossRef Fisher B, Fisher ER (1966) Transmigration of lymph nodes by tumor cells. Science 152:1397–1398CrossRef
5.
go back to reference Dadras SS, Lange-Asschenfeldt B, Velasco P et al (2005) Tumor lymphangiogenesis predicts melanoma metastasis to sentinel lymph nodes. Mod Pathol 18:1232–1242CrossRef Dadras SS, Lange-Asschenfeldt B, Velasco P et al (2005) Tumor lymphangiogenesis predicts melanoma metastasis to sentinel lymph nodes. Mod Pathol 18:1232–1242CrossRef
6.
go back to reference Harrell MI, Iritani BM, Ruddell A (2007) Tumor-induced sentinel lymph node lymphangiogenesis and increased lymph flow precede melanoma metastasis. Am J Pathol 170:774–786CrossRef Harrell MI, Iritani BM, Ruddell A (2007) Tumor-induced sentinel lymph node lymphangiogenesis and increased lymph flow precede melanoma metastasis. Am J Pathol 170:774–786CrossRef
7.
go back to reference Cochran AJ, Morton DL, Stern S et al (2001) Sentinel lymph nodes show profound downregulation of antigen-presenting cells of the paracortex: implications for tumor biology and treatment. Mod Pathol 14:604–608CrossRef Cochran AJ, Morton DL, Stern S et al (2001) Sentinel lymph nodes show profound downregulation of antigen-presenting cells of the paracortex: implications for tumor biology and treatment. Mod Pathol 14:604–608CrossRef
8.
go back to reference Morton DL, Thompson JF, Cochran AJ et al (2006) Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 355:1307–1317CrossRef Morton DL, Thompson JF, Cochran AJ et al (2006) Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 355:1307–1317CrossRef
9.
go back to reference Veronesi U, Adamus J, Bandiera DC et al (1977) Inefficacy of immediate node dissection in stage 1 melanoma of the limbs. N Engl J Med 297:627–630CrossRef Veronesi U, Adamus J, Bandiera DC et al (1977) Inefficacy of immediate node dissection in stage 1 melanoma of the limbs. N Engl J Med 297:627–630CrossRef
10.
go back to reference Veronesi U, Adamus J, Bandiera DC et al (1982) Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer 49:2420–2430CrossRef Veronesi U, Adamus J, Bandiera DC et al (1982) Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer 49:2420–2430CrossRef
11.
go back to reference Sim FH, Taylor WF, Pritchard DJ et al (1986) Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomized study. Mayo Clin Proc. 61:697–705CrossRef Sim FH, Taylor WF, Pritchard DJ et al (1986) Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomized study. Mayo Clin Proc. 61:697–705CrossRef
12.
go back to reference Cascinelli N, Morabito A, Santinami M et al (1998) Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Program Lancet 351:793–796 Cascinelli N, Morabito A, Santinami M et al (1998) Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Program Lancet 351:793–796
13.
go back to reference Balch C, Soong S, Ross M et al (2000) Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0–4.0 mm). Ann Surg Oncol 7:87–97CrossRef Balch C, Soong S, Ross M et al (2000) Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0–4.0 mm). Ann Surg Oncol 7:87–97CrossRef
14.
go back to reference Morton DL, Thompson JF, Cochran AJ et al (2014) Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 370:599–609CrossRef Morton DL, Thompson JF, Cochran AJ et al (2014) Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 370:599–609CrossRef
15.
go back to reference Songun I, Putter H, Kranenbarg EM et al (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449CrossRef Songun I, Putter H, Kranenbarg EM et al (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449CrossRef
16.
go back to reference Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669CrossRef Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669CrossRef
17.
go back to reference Izbicki JR, Passlick B, Pantel K et al (1998) Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg 227:138–144CrossRef Izbicki JR, Passlick B, Pantel K et al (1998) Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg 227:138–144CrossRef
18.
go back to reference Giuliano AE, Ballman KV, McCall L et al (2017) Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA 318:918–926CrossRef Giuliano AE, Ballman KV, McCall L et al (2017) Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA 318:918–926CrossRef
19.
go back to reference D’Cruz AK, Vaish R, Kapre N et al (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373:521–529CrossRef D’Cruz AK, Vaish R, Kapre N et al (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373:521–529CrossRef
20.
go back to reference Balch CM, Cascinelli N, Sim FH (2003) Elective lymph node dissection: Results of prospective randomized surgical trials. In: Balch CM, Houghton AN, Sober AJ et al (eds) Cutaneous melanoma. Quality Medical Publishing, Saint Louis, pp 379–395 Balch CM, Cascinelli N, Sim FH (2003) Elective lymph node dissection: Results of prospective randomized surgical trials. In: Balch CM, Houghton AN, Sober AJ et al (eds) Cutaneous melanoma. Quality Medical Publishing, Saint Louis, pp 379–395
21.
go back to reference Hein DW, Moy RL (1992) Elective lymph node dissection in stage I malignant melanoma: a meta-analysis. Melanoma Res 2:273–277CrossRef Hein DW, Moy RL (1992) Elective lymph node dissection in stage I malignant melanoma: a meta-analysis. Melanoma Res 2:273–277CrossRef
22.
go back to reference Fisher B (1980) Laboratory and clinical research in breast cancer—a personal adventure: the David A. Karnofsky memorial lecture. Cancer Res 40(11):3863–3874 Fisher B (1980) Laboratory and clinical research in breast cancer—a personal adventure: the David A. Karnofsky memorial lecture. Cancer Res 40(11):3863–3874
23.
go back to reference Hellman S (1994) Karnofsky Memorial Lecture. Natural history of small breast cancers. J Clin Oncol 12(10):2229–2234CrossRef Hellman S (1994) Karnofsky Memorial Lecture. Natural history of small breast cancers. J Clin Oncol 12(10):2229–2234CrossRef
24.
go back to reference Halsted WS (1894) I. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894. Ann Surg 20(5):497–555CrossRef Halsted WS (1894) I. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894. Ann Surg 20(5):497–555CrossRef
25.
go back to reference Leong SP, Tseng WW (2014) Micrometastatic cancer cells in lymph nodes, bone marrow, and blood: clinical significance and biologic implications. CA Cancer J Clin 64(3):195–206CrossRef Leong SP, Tseng WW (2014) Micrometastatic cancer cells in lymph nodes, bone marrow, and blood: clinical significance and biologic implications. CA Cancer J Clin 64(3):195–206CrossRef
26.
go back to reference Cady B (1997) Basic principles in surgical oncology. Arch Surg 132(4):338–346CrossRef Cady B (1997) Basic principles in surgical oncology. Arch Surg 132(4):338–346CrossRef
27.
go back to reference Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127(4):392–399CrossRef Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127(4):392–399CrossRef
28.
go back to reference Morton DL, Hoon DS, Cochran AJ et al (2003) Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg 238(4):538–549; discussion 549–550.PubMedPubMedCentral Morton DL, Hoon DS, Cochran AJ et al (2003) Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg 238(4):538–549; discussion 549–550.PubMedPubMedCentral
29.
go back to reference Faries MB, Thompson JF, Cochran AJ et al (2017) Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 8(23):2211–2222CrossRef Faries MB, Thompson JF, Cochran AJ et al (2017) Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 8(23):2211–2222CrossRef
30.
go back to reference Leiter U, Stadler R, Mauch C et al (2016) Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol 17(6):757–767CrossRef Leiter U, Stadler R, Mauch C et al (2016) Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol 17(6):757–767CrossRef
31.
go back to reference Balch CM, Gershenwald JE, Soong SJ et al (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 20(36):6199–6206 27(CrossRef Balch CM, Gershenwald JE, Soong SJ et al (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 20(36):6199–6206 27(CrossRef
32.
go back to reference Gershenwald JE, Scolyer RA, Hess KR et al (2017) Melanoma of skin. In: Amin MB, Edge S, Greene F (eds) AJCC cancer staging manual, 8th edn. Springer, New York Gershenwald JE, Scolyer RA, Hess KR et al (2017) Melanoma of skin. In: Amin MB, Edge S, Greene F (eds) AJCC cancer staging manual, 8th edn. Springer, New York
33.
go back to reference Essner R (2003) Surgical treatment of malignant melanoma. Surg Clin N Am 83(1):109–156CrossRef Essner R (2003) Surgical treatment of malignant melanoma. Surg Clin N Am 83(1):109–156CrossRef
34.
go back to reference Lens MB, Dawes M, Goodacre T, Newton-Bishop JA (2002) Elective lymph node dissection in patients with melanoma: systematic review and meta-analysis of randomized controlled trials. Arch Surg 137(4):458–461CrossRef Lens MB, Dawes M, Goodacre T, Newton-Bishop JA (2002) Elective lymph node dissection in patients with melanoma: systematic review and meta-analysis of randomized controlled trials. Arch Surg 137(4):458–461CrossRef
35.
go back to reference Wong SL, Morton DL, Thompson JF et al (2006) Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol 13(6):809–816CrossRef Wong SL, Morton DL, Thompson JF et al (2006) Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol 13(6):809–816CrossRef
36.
go back to reference Ross MI, Reintgen DS, Balch CM (1993) Selective lymphadenectomy: the emerging role of lymphatic mapping and sentinel node biopsy in the management of early stage melanoma. Semin Surg Oncol 9:219–223PubMed Ross MI, Reintgen DS, Balch CM (1993) Selective lymphadenectomy: the emerging role of lymphatic mapping and sentinel node biopsy in the management of early stage melanoma. Semin Surg Oncol 9:219–223PubMed
37.
go back to reference Miliotes G, Albertini J, Berman C, Messina J, Glass F, Cruse CW, Rapaport D, Puleo C, Fenske N, Petsoglou C, DeConti R, Lyman G, Reintgen DS (1996) The tumor biology of melanoma nodal metastases. Am Surg 62:81–88PubMed Miliotes G, Albertini J, Berman C, Messina J, Glass F, Cruse CW, Rapaport D, Puleo C, Fenske N, Petsoglou C, DeConti R, Lyman G, Reintgen DS (1996) The tumor biology of melanoma nodal metastases. Am Surg 62:81–88PubMed
38.
go back to reference Balch C, Gershenwald JE, Soong S-J, Thompson J, Byrd D, Cascinelli N, Cochran AJ, Coit D, Eggermont A, Johnson T, Kirkwood J, Leong S, McMasters K, Mihn M, Morton D, Ross M, Sondak V (2010) Multivariate analysis of prognostic factors among 2313 patients with stage III melanoma: Comparison of nodal micrometastases versus macrometastases. J Clin Oncol 28:2452–2459CrossRef Balch C, Gershenwald JE, Soong S-J, Thompson J, Byrd D, Cascinelli N, Cochran AJ, Coit D, Eggermont A, Johnson T, Kirkwood J, Leong S, McMasters K, Mihn M, Morton D, Ross M, Sondak V (2010) Multivariate analysis of prognostic factors among 2313 patients with stage III melanoma: Comparison of nodal micrometastases versus macrometastases. J Clin Oncol 28:2452–2459CrossRef
39.
go back to reference Balch CM, Soon SJ, Atkins MB et al (2004) An evidence-based staging system for cutaneous melanoma. CA Cancer J Clin 54:131–149CrossRef Balch CM, Soon SJ, Atkins MB et al (2004) An evidence-based staging system for cutaneous melanoma. CA Cancer J Clin 54:131–149CrossRef
40.
go back to reference Reintgen M, Murray L, Akman K, Giuliano R, Loznicki A, Shivers S, Reintgen DS (2013) Evidence for a better nodal staging system for melanoma: The clinical relevance of metastatic disease confined to the sentinel lymph nodes. Ann Surg Oncol 20:668–674CrossRef Reintgen M, Murray L, Akman K, Giuliano R, Loznicki A, Shivers S, Reintgen DS (2013) Evidence for a better nodal staging system for melanoma: The clinical relevance of metastatic disease confined to the sentinel lymph nodes. Ann Surg Oncol 20:668–674CrossRef
41.
go back to reference Ries LAG, Reichman ME, Lewis DR, Hankey BF, Edwards BK (2003) Cancer survival and incidence from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist 8(6):541–552CrossRef Ries LAG, Reichman ME, Lewis DR, Hankey BF, Edwards BK (2003) Cancer survival and incidence from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist 8(6):541–552CrossRef
42.
go back to reference Merrill RM, Hunter BD (2010) Conditional survival among cancer patients in the United States. Oncologist 15(8):873–882CrossRef Merrill RM, Hunter BD (2010) Conditional survival among cancer patients in the United States. Oncologist 15(8):873–882CrossRef
43.
go back to reference Kerivan L, Reintgen M, Shivers S, Reintgen E, Reintgen DS (2017) Conditional survival in melanoma: meaningful prognostic information for patients and physicians. Presented at the Society of Surgical Oncology Meeting, March. Seattle, Washington Kerivan L, Reintgen M, Shivers S, Reintgen E, Reintgen DS (2017) Conditional survival in melanoma: meaningful prognostic information for patients and physicians. Presented at the Society of Surgical Oncology Meeting, March. Seattle, Washington
45.
go back to reference Rossi CR, Mocellin S, Campana LG et al (2018) Prediction of non-sentinel node status in patients with melanoma and positive sentinel node biopsy: an Italian Melanoma Intergroup (IMI) Study. Ann Surg Oncol 25:271–279CrossRef Rossi CR, Mocellin S, Campana LG et al (2018) Prediction of non-sentinel node status in patients with melanoma and positive sentinel node biopsy: an Italian Melanoma Intergroup (IMI) Study. Ann Surg Oncol 25:271–279CrossRef
Metadata
Title
Lymph node metastasis in melanoma: a debate on the significance of nodal metastases, conditional survival analysis and clinical trials
Authors
Mark B. Faries
Dale Han
Michael Reintgen
Lauren Kerivan
Douglas Reintgen
Corrado Caracò
Publication date
01-08-2018
Publisher
Springer Netherlands
Published in
Clinical & Experimental Metastasis / Issue 5-6/2018
Print ISSN: 0262-0898
Electronic ISSN: 1573-7276
DOI
https://doi.org/10.1007/s10585-018-9898-6

Other articles of this Issue 5-6/2018

Clinical & Experimental Metastasis 5-6/2018 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine