Top

Published in:

01-03-2014 | Melanomas

Prognosis of Patients with Melanoma and Microsatellitosis Undergoing Sentinel Lymph Node Biopsy

Authors: Edmund K. Bartlett, MD, Meera Gupta, MD, Jashodeep Datta, MD, Phyllis A. Gimotty, PhD, DuPont Guerry, MD, Xiaowei Xu, MD, PhD, David E. Elder, MD, Brian J. Czerniecki, MD, PhD, Douglas L. Fraker, MD, Giorgos C. Karakousis, MD

Published in: Annals of Surgical Oncology | Issue 3/2014

Abstract

Introduction

Melanoma microsatellitosis is classified as stage IIIB/C disease and is associated with a poor prognosis. Prognostic factors within this group, however, have not been well characterized.

Methods

We performed a retrospective analysis of 1,621 patients undergoing sentinel lymph node (SLN) biopsy at our institution (1996–2011) to compare patients with (n = 98) and patients without (n = 1,523) microsatellites. Univariate and multivariate logistic and Cox regression analyses were used to identify factors associated with SLN positivity and melanoma-specific survival (MSS) in patients with microsatellites.

Results

Patients with microsatellites were older and had lesions with higher Clark level and greater thickness that more frequently had mitoses, ulceration, and lymphovascular invasion (LVI) (all p < 0.0001). In microsatellite patients, the SLN positivity rate was 43 %. Lesional ulceration (odds ratio [OR] = 2.9, 95 % confidence interval [CI] 1.5–8.6), absent tumor infiltrating lymphocytes (OR = 2.8, 95 % CI 1.1–7.1), and LVI (OR = 3.3, 95 % CI 1.7–10) were significantly associated with SLN positivity by multivariate analysis. With a median follow-up of 4.5 years in survivors, ulceration (hazards ratio [HR] = 3.4, 95 % CI 1.5–7.8) and >1 metastatic LN (HR = 2.7, 95 % CI 1.1–6.6) were significantly associated with decreased MSS by multivariate analysis. In patients without these prognostic factors, the 5-year MSS was 90 % (n = 49) compared with 50 % (n = 23) among patients with ulceration only, 51 % (n = 12) in those with >1 metastatic LN only, or 25 % in those with both (n = 14, p < 0.01).

Discussion

Microsatellitosis was frequently associated with multiple adverse pathologic features. In the absence of ulceration and >1 metastatic LN; however, the outcome for patients with microsatellites compared favorably to stage IIIB patients overall.

Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.PubMedCrossRef

Balch CM, Gershenwald JE, Soong SJ, et al. Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma: comparison of nodal micrometastases versus macrometastases. J Clin Oncol. 2010;28(14):2452–9.PubMedCrossRef

Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17.PubMedCrossRef

Hayes AJ, Clark MA, Harries M, Thomas JM. Management of in-transit metastases from cutaneous malignant melanoma. Br J Surg. 2004;91(6):673–82.PubMedCrossRef

Murali R, Moncrieff MD, Hong J, et al. The prognostic value of tumor mitotic rate and other clinicopathologic factors in patients with locoregional recurrences of melanoma. Ann Surg Oncol. 2010;17(11):2992–9.PubMedCrossRef

Wong JH, Cagle LA, Kopald KH, et al. Natural history and selective management of in transit melanoma. J Surg Oncol. 1990;44(3):146–50.PubMedCrossRef

Edge SB, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th edn. Vol. XV, 2010.

Day CL Jr, Harrist TJ, Gorstein F, et al. Malignant melanoma. Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg. 1981;194(1):108–12.PubMedCrossRef

Leon P, Daly JM, Synnestvedt M, et al. The prognostic implications of microscopic satellites in patients with clinical stage I melanoma. Arch Surg. 1991;126(12):1461–8.PubMedCrossRef

10.

Nagore E, Oliver V, Botella-Estrada R, et al. Prognostic factors in localized invasive cutaneous melanoma: high value of mitotic rate, vascular invasion and microscopic satellitosis. Melanoma Res. 2005;15(3):169–77.PubMedCrossRef

11.

Rao UN, Ibrahim J, Flaherty LE, et al. Implications of microscopic satellites of the primary and extracapsular lymph node spread in patients with high-risk melanoma: pathologic corollary of Eastern Cooperative Oncology Group Trial E1690. J Clin Oncol. 2002;20(8):2053–7.PubMedCrossRef

12.

Shaikh L, Sagebiel RW, Ferreira CM, et al. The role of microsatellites as a prognostic factor in primary malignant melanoma. Arch Dermatol. 2005;141(6):739–42.PubMedCrossRef

13.

Azimi F, Scolyer RA, Rumcheva P, et al. Tumor-infiltrating lymphocyte grade is an independent predictor of sentinel lymph node status and survival in patients with cutaneous melanoma. J Clin Oncol. 2012;30(21):2678–83.PubMedCrossRef

14.

Buzaid AC, Ross MI, Balch CM, et al. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol. 1997;15(3):1039–51.PubMed

15.

Kimsey TF, Cohen T, Patel A, et al. Microscopic satellitosis in patients with primary cutaneous melanoma: implications for nodal basin staging. Ann Surg Oncol. 2009;16(5):1176–83.PubMedCrossRef

16.

Harrist TJ, Rigel DS, Day CL, Jr., et al. “Microscopic satellites” are more highly associated with regional lymph node metastases than is primary melanoma thickness. Cancer. 1984;53(10):2183–7.PubMedCrossRef

17.

Gimotty PA, Guerry D, Ming ME, et al. Thin primary cutaneous malignant melanoma: a prognostic tree for 10-year metastasis is more accurate than American Joint Committee on Cancer staging. J Clin Oncol. 2004;22(18):3668–76.PubMedCrossRef

18.

Kesmodel SB, Karakousis GC, Botbyl JD, et al. Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol. 2005;12(6):449–58.PubMedCrossRef

19.

Gordis L. Epidemiology. Saunders, Elsevier 2009.

20.

Rosner B. Fundamentals of biostatistics, 7th edn. Brooks/Cole Cengage Learning, 2011.

21.

Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer, 2001.CrossRef

22.

Juul SF. An introduction to Stata for health researchers. 3rd edn. StataCorp LP 2010; pp 179–96.

23.

Balch CM. Microscopic satellites around a primary melanoma: another piece of the puzzle in melanoma staging. Ann Surg Oncol. 2009;16(5):1092–4.PubMedCrossRef

24.

Balch CM, Soong S, Ross MI, et al. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial. Ann Surg Oncol. 2000;7(2):87–97.PubMedCrossRef

25.

Borgstein PJ, Meijer S, van Diest PJ. Are locoregional cutaneous metastases in melanoma predictable? Ann Surg Oncol. 1999;6(3):315–21.PubMedCrossRef

26.

Cascinelli N, Bufalino R, Marolda R, et al. Regional non-nodal metastases of cutaneous melanoma. Eur J Surg Oncol. 1986;12(2):175–80.PubMed

27.

Pawlik TM, Ross MI, Thompson JF, et al. The risk of in-transit melanoma metastasis depends on tumor biology and not the surgical approach to regional lymph nodes. J Clin Oncol. 2005;23(21):4588–90.PubMedCrossRef

28.

Weide B, Faller C, Buttner P, et al. Prognostic factors of melanoma patients with satellite or in-transit metastasis at the time of stage III diagnosis. PLoS One. 2013;8(4):e63137.PubMedCentralPubMedCrossRef

Title: Prognosis of Patients with Melanoma and Microsatellitosis Undergoing Sentinel Lymph Node Biopsy
Authors: Edmund K. Bartlett, MD
Meera Gupta, MD
Jashodeep Datta, MD
Phyllis A. Gimotty, PhD
DuPont Guerry, MD
Xiaowei Xu, MD, PhD
David E. Elder, MD
Brian J. Czerniecki, MD, PhD
Douglas L. Fraker, MD
Giorgos C. Karakousis, MD
Publication date: 01-03-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 3/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3388-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognosis of Patients with Melanoma and Microsatellitosis Undergoing Sentinel Lymph Node Biopsy

Abstract

Introduction

Methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Discussion

Please log in to get access to this content

Other articles of this Issue 3/2014

Prognostic Significance of the Highest Peripancreatic Lymph Node in Biliary Tract Adenocarcinoma

Significance of Urinary Tract Involvement in Patients Treated with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Morbidity and Mortality in 1,174 Patients Undergoing Hepatic Parenchymal Transection Using a Stapler Device

HE4 Expression in Plasma Correlates with Surgical Outcome and Overall Survival in Patients with First Ovarian Cancer Relapse

Elevated Preoperative Systemic Inflammatory Markers Predict Poor Outcome in Localized Soft Tissue Sarcoma

Long-Term Outcomes and Prognostic Factors with Reductive Hepatectomy and Sequential Percutaneous Isolated Hepatic Perfusion for Multiple Bilobar Hepatocellular Carcinoma