Top

Published in:

01-12-2011 | Melanomas

Factors Predictive of the Status of Sentinel Lymph Nodes in Melanoma Patients from a Large Multicenter Database

Authors: Richard L. White Jr., MD, Gregory D. Ayers, MS, Virginia H. Stell, BA, Shouluan Ding, PhD, Jeffrey E. Gershenwald, MD, Jonathan C. Salo, MD, Barbara A. Pockaj, MD, Richard Essner, MD, Mark Faries, MD, Kim James Charney, MD, Eli Avisar, MD, Axel Hauschild, MD, Friederike Egberts, MD, Bruce J. Averbook, MD, Carlos A. Garberoglio, MD, John T. Vetto, MD, Merrick I. Ross, MD, David Chu, MD, Vijay Trisal, MD, Harald Hoekstra, MD, Eric Whitman, MD, Harold J. Wanebo, MD, Daniel DeBonis, MD, Michael Vezeridis, MD, Aaron Chevinsky, MD, Mohammed Kashani-Sabet, MD, Yu Shyr, PhD, Lynne Berry, PhD, Zhiguo Zhao, MS, Seng-jaw Soong, PhD, Stanley P. L. Leong, MD, for the Sentinel Lymph Node Working Group

Published in: Annals of Surgical Oncology | Issue 13/2011

Abstract

Background

Numerous predictive factors for cutaneous melanoma metastases to sentinel lymph nodes have been identified; however, few have been found to be reproducibly significant. This study investigated the significance of factors for predicting regional nodal disease in cutaneous melanoma using a large multicenter database.

Methods

Seventeen institutions submitted retrospective and prospective data on 3463 patients undergoing sentinel lymph node (SLN) biopsy for primary melanoma. Multiple demographic and tumor factors were analyzed for correlation with a positive SLN. Univariate and multivariate statistical analyses were performed.

Results

Of 3445 analyzable patients, 561 (16.3%) had a positive SLN biopsy. In multivariate analysis of 1526 patients with complete records for 10 variables, increasing Breslow thickness, lymphovascular invasion, ulceration, younger age, the absence of regression, and tumor location on the trunk were statistically significant predictors of a positive SLN.

Conclusions

These results confirm the predictive significance of the well-established variables of Breslow thickness, ulceration, age, and location, as well as consistently reported but less well-established variables such as lymphovascular invasion. In addition, the presence of regression was associated with a lower likelihood of a positive SLN. Consideration of multiple tumor parameters should influence the decision for SLN biopsy and the estimation of nodal metastatic disease risk.

Chao C, Martin RC 2nd, Ross MI, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol. 2004;11:259–64.PubMedCrossRef

Clary BM, Brady MS, Lewis JJ, Coit DG. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence. Ann Surg. 2001;233:250–8.PubMedCrossRef

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;17:976–83.PubMed

Jacobs IA, Chang CK, Salti GI. Significance of dual-basin drainage in patients with truncal melanoma undergoing sentinel lymph node biopsy. J Am Acad Dermatol. 2003;49:615–9.PubMedCrossRef

Joseph E, Brobeil A, Glass F, et al. Results of complete lymph node dissection in 83 melanoma patients with positive sentinel nodes. Ann Surg Oncol. 1998;5:119–25.PubMedCrossRef

Kruper LL, Spitz FR, Czerniecki BJ, et al. Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma. Cancer. 2006;107:2436–45.PubMedCrossRef

McHugh JB, Su L, Griffith KA, et al. Significance of multiple lymphatic basin drainage in truncal melanoma patients undergoing sentinel lymph node biopsy. Ann Surg Oncol. 2006;13:1216–23.PubMedCrossRef

McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery. 2001;130:151–6.PubMedCrossRef

Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg. 1999;230:453–63.PubMedCrossRef

10.

Mraz-Gernhard S, Sagebiel RW, Kashani-Sabet M, Miller JR 3rd, Leong SP. Prediction of sentinel lymph node micrometastasis by histological features in primary cutaneous malignant melanoma. Arch Dermatol. 1998;134:983–7.PubMedCrossRef

11.

Paek SC, Griffith KA, Johnson TM, et al. The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma. Cancer. 2007;109:100–8.PubMedCrossRef

12.

Porter GA, Ross MI, Berman RS, Lee JE, Mansfield PF, Gershenwald JE. Significance of multiple nodal basin drainage in truncal melanoma patients undergoing sentinel lymph node biopsy. Ann Surg Oncol. 2000;7:256–61.PubMedCrossRef

13.

Rousseau DL Jr, Ross MI, Johnson MM, et al. Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients. Ann Surg Oncol. 2003;10:569–74.PubMedCrossRef

14.

Sondak VK, Taylor JM, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol. 2004;11:247–58.PubMedCrossRef

15.

Taylor RC, Patel A, Panageas KS, Busam KJ, Brady MS. Tumor-infiltrating lymphocytes predict sentinel lymph node positivity in patients with cutaneous melanoma. J Clin Oncol. 2007;25:869–75.PubMedCrossRef

16.

Thompson JF, Shaw HM. Should tumor mitotic rate and patient age, as well as tumor thickness, be used to select melanoma patients for sentinel node biopsy? Ann Surg Oncol. 2004;11:233–5.PubMedCrossRef

17.

Wagner JD, Gordon MS, Chuang TY, et al. Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma. Cancer. 2000;89:453–62.PubMedCrossRef

18.

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;24:4464–71.PubMedCrossRef

19.

Roulin D, Matter M, Bady P, et al. Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution. Eur J Surg Oncol. 2008;34:673–9.PubMedCrossRef

20.

Sassen S, Shaw HM, Colman MH, Scolyer RA, Thompson JF. The complex relationships between sentinel node positivity, patient age, and primary tumor desmoplasia: analysis of 2303 melanoma patients treated at a single center. Ann Surg Oncol. 2008;15:630–7.PubMedCrossRef

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;98:1922–8.PubMedCrossRef

22.

Federico AC, Chagpar AB, Ross MI, et al. Effect of multiple-nodal basin drainage on cutaneous melanoma. Arch Surg. 2008;143:632–7.PubMedCrossRef

23.

Niakosari F, Kahn HJ, McCready D, et al. Lymphatic invasion identified by monoclonal antibody D2–40, younger age, and ulceration: predictors of sentinel lymph node involvement in primary cutaneous melanoma. Arch Dermatol. 2008;144:462–7.PubMedCrossRef

24.

Testori A, De Salvo GL, Montesco MC, et al. Clinical considerations on sentinel node biopsy in melanoma from an Italian multicentric study on 1,313 patients (SOLISM-IMI). Ann Surg Oncol. 2009;16:2018–27.PubMedCrossRef

25.

Mitra A, Conway C, Walker C, et al. Melanoma sentinel node biopsy and prediction models for relapse and overall survival. Br J Cancer. 2010;103:1229–36.PubMedCrossRef

26.

Ellis MC, Weerasinghe R, Corless CL, Vetto JT. Sentinel lymph node staging of cutaneous melanoma: predictors and outcomes. Am J Surg. 2010;199:663–8.PubMedCrossRef

27.

Gershenwald JE, Tseng CH, Thompson W, et al. Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid. Surgery. 1998;124:203–10.PubMedCrossRef

28.

Kaur C, Thomas RJ, Desai N, et al. The correlation of regression in primary melanoma with sentinel lymph node status. J Clin Pathol. 2008;61:297–300.PubMedCrossRef

29.

Morris KT, Busam KJ, Bero S, Patel A, Brady MS. Primary cutaneous melanoma with regression does not require a lower threshold for sentinel lymph node biopsy. Ann Surg Oncol. 2008;15:316–22.PubMedCrossRef

30.

Cook MG, Spatz A, Brocker EB, Ruiter DJ. Identification of histological features associated with metastatic potential in thin (< 1.0 mm) cutaneous melanoma with metastases. A study on behalf of the EORTC Melanoma Group. J Pathol. 2002;197:188–93.PubMedCrossRef

31.

Kretschmer L, Starz H, Thoms KM, et al. Age as a key factor influencing metastasizing patterns and disease-specific survival after sentinel lymph node biopsy for cutaneous melanoma. Int J Cancer. doi:10.1002/ijc.25747.

32.

Leong SP. Selective sentinel lymphadenectomy for malignant melanoma. Surg Clin North Am. 2003;83:157–85.PubMedCrossRef

33.

Balch CM, Gershenwald JE, Soong S, et al. Melanoma of the skin. In: Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A, eds. AJCC cancer staging manual. 7th ed. New York: Springer; 2009. p. 325–43.

34.

Lock-Andersen J, Horn J, Sjøstrand H, Nürnberg BM, Stokholm KH (2006) Sentinel node biopsy in cutaneous melanoma. Scand J Plast Reconstr Surg Hand Surg 40:24–31.PubMedCrossRef

35.

Gromet MA, Epstein WL, Blois MS. The regressing thin malignant melanoma: a distinctive lesion with metastatic potential. Cancer. 1978;42:2282–92.PubMedCrossRef

36.

Slingluff CL Jr, Vollmer RT, Reintgen DS, Seigler HF. Lethal “thin” malignant melanoma. Identifying patients at risk. Ann Surg. 1988;208:150–61.PubMedCrossRef

37.

Guitart J, Lowe L, Piepkorn M, et al. Histological characteristics of metastasizing thin melanomas: a case-control study of 43 cases. Arch Dermatol. 2002;138:603–8.PubMedCrossRef

38.

Leiter U, Buettner PG, Eigentler TK, Garbe C. Prognostic factors of thin cutaneous melanoma: an analysis of the central malignant melanoma registry of the German Dermatological Society. J Clin Oncol. 2004;22:3660–7.PubMedCrossRef

39.

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;22:3668–76.PubMedCrossRef

40.

Kelly JW, Sagebiel RW, Blois MS. Regression in malignant melanoma. A histologic feature without independent prognostic significance. Cancer. 1985;56:2287–91.PubMedCrossRef

41.

Homsi J, Kashani-Sabet M, Messina JL, Daud A. Cutaneous melanoma: prognostic factors. Cancer Control. 2005;12:223–9.PubMed

42.

Gogas H, Ioannovich J, Dafni U, et al. Prognostic significance of autoimmunity during treatment of melanoma with interferon. N Engl J Med. 2006;354:709–18.PubMedCrossRef

43.

Phan GQ, Attia P, Steinberg SM, White DE, Rosenberg SA. Factors associated with response to high-dose interleukin-2 in patients with metastatic melanoma. J Clin Oncol. 2001;19:3477–82.PubMed

44.

Boasberg PD, Hoon DS, Piro LD, et al. Enhanced survival associated with vitiligo expression during maintenance biotherapy for metastatic melanoma. J Invest Dermatol. 2006;126:2658–63.PubMedCrossRef

45.

Nordlund JJ, Kirkwood JM, Forget BM, Milton G, Albert DM, Lerner AB. Vitiligo in patients with metastatic melanoma: a good prognostic sign. J Am Acad Dermatol. 1983;9:689–96.PubMedCrossRef

46.

College of American Pathologists. Melanoma of the skin cancer protocol. http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinMelanoma_11protocol.pdf (April 6, 2011).

47.

Liu L-C, Parrett BM, Jenkins T, et al. Selective sentinel lymph node dissection for melanoma: importance of harvesting nodes with lower radioactive counts without the need for blue dye. Ann Surg Oncol. doi:10.1245/s10434-011-1689-0.

Title: Factors Predictive of the Status of Sentinel Lymph Nodes in Melanoma Patients from a Large Multicenter Database
Authors: Richard L. White Jr., MD
Gregory D. Ayers, MS
Virginia H. Stell, BA
Shouluan Ding, PhD
Jeffrey E. Gershenwald, MD
Jonathan C. Salo, MD
Barbara A. Pockaj, MD
Richard Essner, MD
Mark Faries, MD
Kim James Charney, MD
Eli Avisar, MD
Axel Hauschild, MD
Friederike Egberts, MD
Bruce J. Averbook, MD
Carlos A. Garberoglio, MD
John T. Vetto, MD
Merrick I. Ross, MD
David Chu, MD
Vijay Trisal, MD
Harald Hoekstra, MD
Eric Whitman, MD
Harold J. Wanebo, MD
Daniel DeBonis, MD
Michael Vezeridis, MD
Aaron Chevinsky, MD
Mohammed Kashani-Sabet, MD
Yu Shyr, PhD
Lynne Berry, PhD
Zhiguo Zhao, MS
Seng-jaw Soong, PhD
Stanley P. L. Leong, MD
for the Sentinel Lymph Node Working Group
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 13/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-1826-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Factors Predictive of the Status of Sentinel Lymph Nodes in Melanoma Patients from a Large Multicenter Database

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 13/2011

Robot-Assisted Spleen-Preserving Laparoscopic Distal Pancreatectomy

Decreased Expression of RASSF6 Is a Novel Independent Prognostic Marker of a Worse Outcome in Gastric Cancer Patients after Curative Surgery

Adjuvant Chemolipiodolization Reduces Early Recurrence Derived from Intrahepatic Metastasis of Hepatocellular Carcinoma After Hepatectomy

Is Neo-adjuvant Chemotherapy a “Waiver” of Extensive Upper Abdominal Surgery in Advanced Epithelial Ovarian Cancer?

Transcriptional Factor Prox1 Plays an Essential Role in the Antiproliferative Action of Interferon-γ in Esophageal Cancer Cells

Limitations of the ACS NSQIP in Thyroid Surgery