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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2009

01-11-2009 | Melanomas

Prognostic Significance of a Positive Nonsentinel Lymph Node in Cutaneous Melanoma

Authors: Amir A. Ghaferi, MD, Sandra L. Wong, MD, MS, Timothy M. Johnson, MD, Lori Lowe, MD, Alfred E. Chang, MD, Vincent M. Cimmino, MD, Carol R. Bradford, MD, Riley S. Rees, MD, Michael S. Sabel, MD

Published in: Annals of Surgical Oncology | Issue 11/2009

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Abstract

Purpose

Sentinel lymph node (SLN) biopsy provides important prognostic information for patients with cutaneous melanoma. There may be additional prognostic significance to melanoma spreading from the SLN to nonsentinel lymph nodes (NSLN). We examined the implications of a positive NSLN for overall and distant disease-free survival.

Methods

Using a prospectively maintained, Institutional Review Board-approved melanoma database we studied patients who had a cutaneous melanoma, a positive SLN, and a completion lymph node dissection (CLND). Survival was determined using a combination of hospital records and the Social Security Death Index (SSDI). Univariate and multivariate Cox regression analysis was performed to further characterize predictors of overall and distant disease-free survival. Kaplan–Meier analysis was used to generate survival curves.

Results

A total of 429 patients with positive SLN biopsies were identified, with at least one positive NSLN identified in 71 (17%). Median follow-up time was 36.8 months. Presence of a positive NSLN was significantly associated with poor outcome, although long-term survival was possible. Presence of ulceration, high mitotic rate, angiolymphatic invasion, total number of positive nodes, and volume of disease >1% in the SLN were significant predictors of survival on univariate analysis, but lost significance on multivariate. Multivariate Cox analysis revealed several predictors of overall survival: increasing age [hazard ratio (HR) 1.04, P < 0.01], Breslow depth (HR 1.76, P < 0.01), presence of extracapsular extension in the SLN (HR 2.39, P < 0.01), and positive NSLN (HR 1.92, P < 0.01).

Conclusion

Among node-positive melanoma patients, presence of a positive NSLN is a highly significant poor prognostic sign, even after considering the total number of positive nodes and volume of disease in the SLN. CLND after a positive SLN provides this important prognostic information.
Literature
1.
Gershenwald JE, Andtbacka RH, Prieto VG, et al. Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol. 2008;26(26):4296–303.CrossRefPubMed
2.
Sabel MS, Griffith KA, Arora A, et al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007;141:728–35.CrossRefPubMed
3.
Beitsch PD, Balch CM. Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection. Am J Surg. 1992;164:462–6.CrossRefPubMed
4.
Ingvar C, Erichsen C, Johnsson PE. Morbidity following prophylactic and therapeutic lymph node dissection for melanoma—A comparison. Tumori. 1984;70:529–33.PubMed
5.
Bowsher WG, Taylor BA, Hughes LE. Morbidity, mortality and local recurrence following regional node dissection for melanoma. Br J Surg. 1986;73:906–8.CrossRefPubMed
6.
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.CrossRefPubMed
7.
Guggenheim MM, Hug U, Jung FJ, et al. Morbidity and recurrence after completion lymph node dissection following sentinel lymph node biopsy in cutaneous malignant melanoma. Ann Surg. 2008;247(4):687–93.CrossRefPubMed
8.
Elias N, Tanabe KK, Sober AJ, et al. Is completion lymphadenectomy after a positive sentinel lymph node biopsy for cutaneous melanoma always necessary? Arch Surg. 2004;139(4):400–4 (discussion 404–5).CrossRefPubMed
9.
Carlson GW, Murray DR, Lyles RH, et al. The amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance? Ann Surg Oncol. 2003;10(5):575–81.CrossRefPubMed
10.
Cochran AJ, Wen DR, Huang RR, et al. Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol. 2004;17(7):747–55.CrossRefPubMed
11.
Debarbieux S, Duru G, Dalle S, et al. Sentinel lymph node biopsy in melanoma: a micromorphometric study relating to prognosis and completion lymph node dissection. Br J Dermatol. 2007;157(1):58–67.CrossRefPubMed
12.
Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17(3):976–83.PubMed
13.
Lee JH, Essner R, Torisu-Itakura H, et al. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma. J Clin Oncol. 2004;22(18):3677–84.CrossRefPubMed
14.
McMasters KM, Wong SL, Edwards MJ, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol. 2002;9(2):137–41.CrossRefPubMed
15.
Page AJ, Carlson GW, Delman KA, et al. Prediction of nonsentinel lymph node involvement in patients with a positive sentinel lymph node in malignant melanoma. Am Surg. 2007;73(7):674–8 (discussion 678–9).PubMed
16.
Reeves ME, Delgado R, Busam KJ, et al. Prediction of nonsentinel lymph node status in melanoma. Ann Surg Oncol. 2003;10(1):27–31.CrossRefPubMed
17.
Sabel MS, Griffith K, Sondak VK, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg. 2005;201(1):37–47.CrossRefPubMed
18.
Wong SL, Morton DL, Thompson JF, et al. Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol. 2006;13(6):809–16.CrossRefPubMed
19.
Frankel TL, Griffith KA, Lowe L, et al. Do micromorphometric features of metastatic deposits within sentinel nodes predict nonsentinel lymph node involvement in melanoma? Ann Surg Oncol. 2008;15(9):2403–11.CrossRefPubMed
20.
Glumac N, Hocevar M, Zadnik V, Snoj M. Sentinel lymph node micrometastasis may predict non-sentinel involvement in cutaneous melanoma patients. J Surg Oncol. 2008;98(1):46–8.CrossRefPubMed
21.
Guggenheim M, Dummer R, Jung FJ, et al. 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. Br J Cancer. 2008;98(12):1922–8.CrossRefPubMed
22.
Roka F, Mastan P, Binder M, et al. Prediction of non-sentinel node status and outcome in sentinel node-positive melanoma patients. Eur J Surg Oncol. 2008;34(1):82–8.PubMed
23.
Rossi CR, De Salvo GL, Bonandini E, et al. Factors predictive of nonsentinel lymph node involvement and clinical outcome in melanoma patients with metastatic sentinel lymph node. Ann Surg Oncol. 2008;15(4):1202–10.CrossRefPubMed
24.
Satzger I, Volker B, Meier A, et al. Criteria in sentinel lymph nodes of melanoma patients that predict involvement of nonsentinel lymph nodes. Ann Surg Oncol. 2008;15(6):1723–32.CrossRefPubMed
25.
Ariyan C, Brady MS, Gonen M, et al. Positive nonsentinel node status predicts mortality in patients with cutaneous melanoma. Ann Surg Oncol. 2008;16:186–90.CrossRefPubMed
26.
Cascinelli N, Bombardieri E, Bufalino R, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24(27):4464–71.CrossRefPubMed
27.
Torisu-Itakura H, Lee JH, Scheri RP, et al. Molecular characterization of inflammatory genes in sentinel and nonsentinel nodes in melanoma. Clin Cancer Res. 2007;13(11):3125–32.CrossRefPubMed
Metadata
Title
Prognostic Significance of a Positive Nonsentinel Lymph Node in Cutaneous Melanoma
Authors
Amir A. Ghaferi, MD
Sandra L. Wong, MD, MS
Timothy M. Johnson, MD
Lori Lowe, MD
Alfred E. Chang, MD
Vincent M. Cimmino, MD
Carol R. Bradford, MD
Riley S. Rees, MD
Michael S. Sabel, MD
Publication date
01-11-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0665-4

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