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01-12-2010 | Melanomas

The Prognostic Significance of Nonsentinel Lymph Node Metastasis in Melanoma

Authors: Russell E. Brown, MD, Merrick I. Ross, MD, Michael J. Edwards, MD, R. Dirk Noyes, MD, Douglas S. Reintgen, MD, Lee J. Hagendoorn, MBA, Arnold J. Stromberg, PhD, Robert C. G. Martin, MD, PhD, Kelly M. McMasters, MD, PhD, Charles R. Scoggins, MD, MBA

Published in: Annals of Surgical Oncology | Issue 12/2010

Abstract

Background

We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival.

Materials and methods

Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥1.0 mm in Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free survival (DFS) and overall survival (OS) were computed by Kaplan–Meier analysis; univariate and multivariate analyses were performed to identify factors associated with differences in survival among groups.

Results

A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6% for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4%, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence of ulceration, Clark level ≥ IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not.

Conclusions

NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive lymph nodes or the lymph node ratio.

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Title: The Prognostic Significance of Nonsentinel Lymph Node Metastasis in Melanoma
Authors: Russell E. Brown, MD
Merrick I. Ross, MD
Michael J. Edwards, MD
R. Dirk Noyes, MD
Douglas S. Reintgen, MD
Lee J. Hagendoorn, MBA
Arnold J. Stromberg, PhD
Robert C. G. Martin, MD, PhD
Kelly M. McMasters, MD, PhD
Charles R. Scoggins, MD, MBA
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 12/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1208-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The Prognostic Significance of Nonsentinel Lymph Node Metastasis in Melanoma

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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