Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2013

01-09-2013 | Melanomas

Outcome of Clinical Stage III Melanoma Patients with FDG-PET and Whole-Body CT Added to the Diagnostic Workup

Authors: M. G. Niebling, MD, E. Bastiaannet, PhD, O. S. Hoekstra, PhD, J. J. Bonenkamp, PhD, R. Koelemij, PhD, H. J. Hoekstra, PhD

Published in: Annals of Surgical Oncology | Issue 9/2013

Login to get access

Abstract

Background

Combined whole-body FDG-PET and CT provide the most comprehensive staging of melanoma patients with palpable lymph node metastases (LNM). The aim of this study is to analyze survival of FDG-PET and CT negative or positive melanoma patients and to assess which factors have independent prognostic impact on survival of these patients.

Methods

Patients with palpable and histologically or cytologically proven LNM of melanoma, referred to participating hospitals for examination with FDG-PET and CT, were selected from a previous study. Melanoma-specific survival (MSS) and disease-free period (DFP) were analyzed for FDG-PET and CT positive and negative patients using the Kaplan–Meier method. Cox-regression analysis was performed to analyze which patient or melanoma characteristics had significant impact on MSS or DFP.

Results

For all 252 patients 5-year MSS was 38.2 %. For FDG-PET and CT negative and positive patients 5-year MSS was 47.6 and 16.9 %, respectively. Disease-free period for FDG-PET and CT negative patients was 46.0 % after 5 years. Gender, a positive FDG-PET and CT, LNM in axilla compared to head or neck, and presence of extranodal growth were independent factors for worse MSS in all patients. Positive FDG-PET and CT was the most important prognostic factor for MSS with a hazard ratio of 2.54 (95 % CI, 1.55–4.17, P < 0.001).

Conclusions

Staging melanoma patients with palpable LNM is more accurate when whole-body FDG-PET and CT is added to the diagnostic workup. Hence, FDG-PET and CT, preferably combined, are indicated in the staging of clinical stage III melanoma patients.
Literature
1.
2.
Kruijff S, Bastiaannet E, Francken AB, Schaapveld M, van der Aa M, Hoekstra HJ. Breslow thickness in the Netherlands: a population-based study of 40,880 patients comparing young and elderly patients. Br J Cancer. 2012;107:570–4.PubMedCrossRef
3.
Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol. 2005;6:608–21.PubMedCrossRef
4.
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
5.
Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 2012;30:2912–8.PubMedCrossRef
6.
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
7.
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
8.
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
9.
Wevers KP, Bastiaannet E, Poos HP, van Ginkel RJ, Plukker JT, Hoekstra HJ. Therapeutic lymph node dissection in melanoma: different prognosis for different macrometastasis sites? Ann Surg Oncol. 2012;19:3913–8.PubMedCrossRef
10.
Romano E, Scordo M, Dusza SW, Coit DG, Chapman PB. Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol. 2010;28:3042–7.PubMedCrossRef
11.
Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg. 1995;181:193–201.PubMed
12.
Francken AB, Accortt NA, Shaw HM, Wiener M, Soong SJ, Hoekstra HJ, et al. Prognosis and determinants of outcome following locoregional or distant recurrence in patients with cutaneous melanoma. Ann Surg Oncol. 2008;15:1476–84.PubMedCrossRef
13.
Roses DF, Karp NS, Oratz R, Dubin N, Harris MN, Speyer J, et al. Survival with regional and distant metastases from cutaneous malignant melanoma. Surg Gynecol Obstet. 1991;172:262–8.PubMed
14.
Soong SJ, Harrison RA, McCarthy WH, Urist MM, Balch CM. Factors affecting survival following local, regional, or distant recurrence from localized melanoma. J Surg Oncol. 1998;67:228–33.PubMedCrossRef
15.
Howard JH, Thompson JF, Mozzillo N, Nieweg OE, Hoekstra HJ, Roses DF, et al. Metastasectomy for distant metastatic melanoma: analysis of data from the first multicenter selective lymphadenectomy trial (MSLT-I). Ann Surg Oncol. 2012;19:2547–55.PubMedCrossRef
16.
Ollila DW. Complete metastasectomy in patients with stage IV metastatic melanoma. Lancet Oncol. 2006;7:919–24.PubMedCrossRef
17.
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
18.
Flaherty KT, Infante JR, Daud A, Gonzalez R, Kefford RF, Sosman J, et al. Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med. 2012;367:1694–703.PubMedCrossRef
19.
Bastiaannet E, Oyen WJ, Meijer S, Hoekstra OS, Wobbes T, Jager PL, et al. Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients. Br J Surg. 2006;93:243–9.PubMedCrossRef
20.
Mohr P, Eggermont AM, Hauschild A, Buzaid A. Staging of cutaneous melanoma. Ann Oncol. 2009;20 Suppl 6:vi14–21.PubMedCrossRef
21.
Zukauskaite R, Schmidt H, Asmussen JT, Hansen O, Bastholt L. Asymptomatic brain metastases in patients with cutaneous metastatic malignant melanoma. Melanoma Res. 2013;23:21–6.PubMedCrossRef
22.
Aloia TA, Gershenwald JE, Andtbacka RH, Johnson MM, Schacherer CW, Ng CS, et al. Utility of computed tomography and magnetic resonance imaging staging before completion lymphadenectomy in patients with sentinel lymph node-positive melanoma. J Clin Oncol. 2006;24:2858–65.PubMedCrossRef
23.
Bastiaannet E, Uyl-de Groot CA, Brouwers AH, van der Jagt EJ, Hoekstra OS, Oyen W, et al. Cost-effectiveness of adding FDG-PET or CT to the diagnostic work-up of patients with stage III melanoma. Ann Surg. 2012;255:771–6.PubMedCrossRef
24.
Spatz A, Batist G, Eggermont AM. The biology behind prognostic factors of cutaneous melanoma. Curr Opin Oncol. 2010;22:163–8.PubMedCrossRef
25.
Joosse A, Collette S, Suciu S, Nijsten T, Lejeune F, Kleeberg UR, et al. Superior outcome of women with stage I/II cutaneous melanoma: pooled analysis of four European organisation for research and treatment of cancer phase III trials. J Clin Oncol. 2012;30:2240–7.PubMedCrossRef
26.
Burmeister BH, Smithers BM, Poulsen M, McLeod GR, Bryant G, Tripcony L, et al. Radiation therapy for nodal disease in malignant melanoma. World J Surg. 1995;19:369–71.PubMedCrossRef
27.
Corry J, Smith JG, Bishop M, Ainslie J. Nodal radiation therapy for metastatic melanoma. Int J Radiat Oncol Biol Phys. 1999;44:1065–9.PubMedCrossRef
28.
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;351:793–6.PubMedCrossRef
29.
Debarbieux S, Duru G, Dalle S, Beatrix O, Balme B, Thomas L. Sentinel lymph node biopsy in melanoma: a micromorphometric study relating to prognosis and completion lymph node dissection. Br J Dermatol. 2007;157:58–67.PubMedCrossRef
30.
Francischetto T, Spector N, Neto Rezende JF, de Azevedo Antunes M, de Oliveira Romano S, Small IA, et al. Influence of sentinel lymph node tumor burden on survival in melanoma. Ann Surg Oncol. 2010;17:1152–8.PubMedCrossRef
31.
Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.PubMedCrossRef
32.
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
33.
O’Brien CJ, Petersen-Schaefer K, Stevens GN, Bass PC, Tew P, Gebski VJ, et al. Adjuvant radiotherapy following neck dissection and parotidectomy for metastatic malignant melanoma. Head Neck. 1997;19:589–94.PubMedCrossRef
34.
Pearlman NW, McCarter MD, Frank M, Hurtubis C, Merkow RP, Franklin WA, et al. Size of sentinel node metastases predicts other nodal disease and survival in malignant melanoma. Am J Surg. 2006;192:878–81.PubMedCrossRef
35.
Scheri RP, Essner R, Turner RR, Ye X, Morton DL. Isolated tumor cells in the sentinel node affect long-term prognosis of patients with melanoma. Ann Surg Oncol. 2007;14:2861–6.PubMedCrossRef
36.
van Akkooi AC, Nowecki ZI, Voit C, Schäfer-Hesterberg G, Michej W, de Wilt JH, et al. Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg. 2008;248:949–55.PubMedCrossRef
37.
Wright EH, Stanley PR, Roy A. Evaluation of sentinel lymph nodes positive for melanoma for features predictive of non-sentinel nodal disease and patient prognosis: a 49 patient series. J Plast Reconstr Aesthet Surg. 2010;63:e500–2.PubMedCrossRef
38.
Kruijff S, Bastiaannet E, Suurmeijer AJ, Hoekstra HJ. Detection of melanoma nodal metastases; differences in detection between elderly and younger patients do not affect survival. Ann Surg Oncol. 2010;17:3008–14.PubMedCrossRef
39.
Jakub JW, Huebner M, Shivers S, Nobo C, Puleo C, Harmsen WS, et al. The number of lymph nodes involved with metastatic disease does not affect outcome in melanoma patients as long as all disease is confined to the sentinel lymph node. Ann Surg Oncol. 2009;16:2245–51.PubMedCrossRef
40.
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
41.
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
42.
Cohn-Cedermark G, Mansson-Brahme E, Rutqvist LE, Larsson O, Singnomklao T, Ringborg U. Metastatic patterns, clinical outcome, and malignant phenotype in malignant cutaneous melanoma. Acta Oncol. 1999;38:549–57.PubMedCrossRef
43.
Hoyt DJ, Fisher SR. Survival following recurrent malignant melanoma of the head and neck. Laryngoscope. 1989;99:586–9.PubMedCrossRef
44.
Murali R, Moncrieff MD, Hong J, Cooper CL, Shingde MV, Samuel DG, et al. The prognostic value of tumor mitotic rate and other clinicopathologic factors in patients with locoregional recurrences of melanoma. Ann Surg Oncol. 2010;17:2992–9.PubMedCrossRef
45.
Soong SJ, Harrison RA, McCarthy WH, Urist MM, Balch CM. Factors affecting survival following local, regional, or distant recurrence from localized melanoma. J Surg Oncol. 1998;67:228–33.PubMedCrossRef
46.
Dong XD, Tyler D, Johnson JL, DeMatos P, Seigler HF. Analysis of prognosis and disease progression after local recurrence of melanoma. Cancer. 2000;88:1063–71.PubMedCrossRef
47.
White RR, Stanley WE, Johnson JL, Tyler DS, Seigler HF. Long-term survival in 2,505 patients with melanoma with regional lymph node metastasis. Ann Surg. 2002;235:879–87.PubMedCrossRef
48.
Fournier K, Xing Y, Ross M, Lee JE, Gershenwald JE, Mansfield PF, et al. Survival in patients with synchronous versus metachronous lymph node (LN) involvement in stage III melanoma: is there a difference? 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition). J Clin Oncol. 2008;26(No 15S):9034.
Metadata
Title
Outcome of Clinical Stage III Melanoma Patients with FDG-PET and Whole-Body CT Added to the Diagnostic Workup
Authors
M. G. Niebling, MD
E. Bastiaannet, PhD
O. S. Hoekstra, PhD
J. J. Bonenkamp, PhD
R. Koelemij, PhD
H. J. Hoekstra, PhD
Publication date
01-09-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2969-7

Other articles of this Issue 9/2013

Annals of Surgical Oncology 9/2013 Go to the issue

Hepatobiliary Tumors

Financial Comparison of Laparoscopic Versus Open Hepatic Resection Using Deviation-Based Cost Modeling

Gynecologic Oncology

Lung Resistance-Related Protein (LRP) Expression in Malignant Ascitic Cells as a Prognostic Marker for Advanced Ovarian Serous Carcinoma

Pancreatic Tumors

Posterior Approach for Laparoscopic Pancreaticoduodenectomy to Prevent Replaced Hepatic Artery Injury

Healthcare Policy and Outcomes

The Financial Burden of Reexcising Incompletely Excised Soft Tissue Sarcomas: A Cost Analysis

Thoracic Oncology

Lymph Node Harvest in Esophageal Cancer After Neoadjuvant Chemoradiotherapy

Bone and Soft Tissue Sarcomas

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GIST): The EORTC STBSG Experience