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Open Access 01-11-2012 | Melanomas

Therapeutic Lymph Node Dissection in Melanoma: Different Prognosis for Different Macrometastasis Sites?

Authors: K. P. Wevers, MD, E. Bastiaannet, MSc, PhD, H. P. A. M. Poos, MD, R. J. van Ginkel, MD, PhD, J. T. Plukker, MD, PhD, H. J. Hoekstra, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2012

Abstract

Background

The prognostic significance of primary tumor location, especially the poor prognosis for melanomas in the scalp and neck region, is well established. However, the prognosis for different sites of nodal macrometastasis has never been studied. This study investigated the prognostic value of the location of macrometastasis in terms of recurrence and survival rates after therapeutic lymph node dissection (TLND).

Methods

All consecutive FDG-PET-staged melanoma patients with palpable and cytologically proven lymph node metastases operated at our clinic between 2003 and 2011 were included. Disease-free survival and disease-specific survival (DSS) were compared for nodal metastases in the groin, axilla, and neck regions by multivariable analysis.

Results

A total of 149 patients underwent TLND; there were 70 groin (47 %), 57 axillary (38 %), and 22 neck (15 %) dissections. During a median follow-up of 18 (range 1–98) months, 102 patients (68 %) developed recurrent disease. Distant recurrence was the first sign of progressive disease in 78, 76, and 55 % of the groin, axilla, and neck groups, respectively (p = 0.26). Low involved/total lymph nodes (L/N) ratio (p < 0.001) and absence of extranodal growth pattern (p = 0.05) were independent predictors of a longer disease-free survival. For DSS, neck site of nodal metastasis (p = 0.02) and low L/N ratio (p < 0.001) were independent predictors of long survival. The estimated 5-year DSS for the groin, axilla, and neck sites was 28, 34, and 66 %, respectively.

Conclusions

There seems significantly longer DSS after TLND for nodal macrometastases in the neck compared to axillary and groin sites, although larger series should confirm this finding.

Dutch Comprehensive Cancer Centers. 2011. http://ikcnet.nl/. Accessed August 2011.

van der Aa MA, de Vries E, Hoekstra HJ, Coebergh JW, Siesling S. Sociodemographic factors and incidence of melanoma in the Netherlands, 1994–2005. Eur J Cancer. 2011;47:1056–60.PubMedCrossRef

Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.PubMedCrossRef

Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol. 2005;6:608–21.PubMedCrossRef

Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Ding S, Byrd DR, 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;28:2452–9.PubMedCrossRef

Balch CM, Soong SJ, Bartolucci AA, Urist MM, Karakousis CP, Smith TJ, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg. 1996;224:255–63.PubMedCrossRef

Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet. 1998;351(9105):793–6.PubMedCrossRef

Hughes TM, A’Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg. 2000;87:892–901.PubMedCrossRef

van Akkooi AC, Bouwhuis MG, van Geel AN, Hoedemaker R, Verhoef C, Grunhagen DJ, et al. Morbidity and prognosis after therapeutic lymph node dissections for malignant melanoma. Eur J Surg Oncol. 2007;33:102–8.PubMedCrossRef

10.

Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on cancer melanoma staging system. J Clin Oncol. 2001;19:3622–34.PubMed

11.

Kruijff S, Bastiaannet E, Kobold AC, van Ginkel RJ, Suurmeijer AJ, Hoekstra HJ. S-100B concentrations predict disease-free survival in stage III melanoma patients. Ann Surg Oncol. 2009;16:3455–62.PubMedCrossRef

12.

Murali R, Desilva C, Thompson JF, Scolyer RA. Factors predicting recurrence and survival in sentinel lymph node–positive melanoma patients. Ann Surg. 2011;253:1155–64.PubMedCrossRef

13.

Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the surveillance, epidemiology, and end results (SEER) program. Arch Dermatol. 2008;144:515–21.PubMedCrossRef

14.

Bastiaannet E, Wobbes T, Hoekstra OS, van der Jagt EJ, Brouwers AH, Koelemij R, et al. Prospective comparison of [¹⁸F] fluorodeoxyglucose positron emission tomography and computed tomography in patients with melanoma with palpable lymph node metastases: diagnostic accuracy and impact on treatment. J Clin Oncol. 2009;27:4774–80.PubMedCrossRef

15.

Poos HP, Kruijff S, Bastiaannet E, van Ginkel RJ, Hoekstra HJ. Therapeutic groin dissection for melanoma: risk factors for short term morbidity. Eur J Surg Oncol. 2009;35:877–83.PubMedCrossRef

16.

Bastiaannet E, Beukema JC, Hoekstra HJ. Radiation therapy following lymph node dissection in melanoma patients: treatment, outcome and complications. Cancer Treat Rev. 2005;31:18–26.PubMedCrossRef

17.

Henderson MA, Burmeister B, Thompson JF, Di Iulio J, Fisher R, Hong A, et al. Adjuvant radiotherapy and regional lymph node field control in melanoma patients after lymphadenectomy: results of an intergroup randomized trial (ANZMTG 01.02/TROG 02.01). Ann Surg Oncol. 2009;27(18S):LBA9084.

18.

Rossi CR, Mocellin S, Pasquali S, Pilati P, Nitti D. N-ratio: a novel independent prognostic factor for patients with stage-III cutaneous melanoma. Ann Surg Oncol. 2008;15:310–5.PubMedCrossRef

19.

Xing Y, Badgwell BD, Ross MI, Gershenwald JE, Lee JE, Mansfield PF, et al. Lymph node ratio predicts disease-specific survival in melanoma patients. Cancer. 2009;115:2505–13.PubMedCrossRef

20.

Berger AC, Fierro M, Kairys JC, Berd D, Sato T, Andrel J, et al. Lymph node ratio is an important and independent prognostic factor for patients with stage III melanoma. J Surg Oncol. 2012;105:15–20.PubMedCrossRef

21.

Prens SP, van der Ploeg AP, van Akkooi AC, van Montfort CA, van Geel AN, de Wilt JH, et al. Outcome after therapeutic lymph node dissection in patients with unknown primary melanoma site. Ann Surg Oncol. 2011;18:3586–92.PubMedCrossRef

22.

de Vries M, Speijers MJ, Bastiaannet E, Plukker JT, Brouwers AH, van Ginkel RJ, et al. Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma. Eur J Surg Oncol. 2011;37:681–7.PubMedCrossRef

Title: Therapeutic Lymph Node Dissection in Melanoma: Different Prognosis for Different Macrometastasis Sites?
Authors: K. P. Wevers, MD
E. Bastiaannet, MSc, PhD
H. P. A. M. Poos, MD
R. J. van Ginkel, MD, PhD
J. T. Plukker, MD, PhD
H. J. Hoekstra, MD, PhD
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 12/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2401-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Therapeutic Lymph Node Dissection in Melanoma: Different Prognosis for Different Macrometastasis Sites?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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