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 9/2015

01-09-2015 | Melanomas

Tumor Mitotic Rate Added to the Equation: Melanoma Prognostic Factors Changed?

A Single-Institution Database Study on the Prognostic Value of Tumor Mitotic Rate for Sentinel Lymph Node Status and Survival of Cutaneous Melanoma Patients

Authors: M. J. Speijers, MD, E. Bastiaannet, PhD, S. Sloot, MD, A. J. H. Suurmeijer, MD, PhD, H. J. Hoekstra, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2015

Login to get access

Abstract

Background

This study aimed to investigate the predictive value of the tumor mitotic rate per mm2 (TMR) for sentinel lymph node (SLN) status and survival in intermediate and thick cutaneous melanoma.

Methods

Patients treated for stage I and II melanoma with wide local excision and SLN biopsy between May 1995 and May 2013 were analyzed. In case of insufficient data regarding TMR, pathology slides were reanalyzed. Prognostic factors for SLN status and survival were analyzed with the emphasis on TMR, which was analyzed as a continuous variable, dichotomized (median value) and categorized by two methods.

Results

The study analyzed 453 patients with complete TMR data. The median Breslow thickness was 2.20 mm, and 31.8 % of patients had tumor-positive sentinel lymph node biopsies (SLNBs). In the univariate analysis, TMR was associated with tumor-positive SLNB. This association was not significant in the multivariate analysis. Breslow thickness, primary tumor location on trunk and legs, and younger age were associated with tumor-positive SNLB. At a median follow-up of 47 months, 119 patients (26.3 %) had recurrent disease, and 92 (20.3 %) had died of melanoma. In the univariate analysis, TMR could be established as a significant prognostic factor for disease-free and disease-specific survival, but not in the multivariate analyses. Breslow thickness, ulcerated melanoma, and tumor-positive SLNB were significant prognostic factors for survival.

Conclusion

The study was unable to establish TMR as an independent prognostic factor associated with the presence of SLN metastasis. Regarding survival, increasing TMR showed a strong association with decreased survival in the univariate analysis, but this association was rendered nonsignificant by the importance of Breslow thickness and ulceration status in the multivariate model.
Literature
1.
2.
Thompson JF, Soong SJ, Balch CM, et al. Prognostic significance of mitotic rate in localized primary cutaneous melanoma: an analysis of patients in the multi-institutional American Joint Committee on Cancer melanoma staging database. J Clin Oncol. 2011;29:2199–205.PubMedCentralPubMedCrossRef
3.
Sondak VK, Taylor JMG, 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
4.
Paek SC, Griffith KA, Johnson TM, et al. The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma. Cancer. 2006;109:100–8.CrossRef
5.
Roach BA, Burton AL, Mays MP, et al. Does mitotic rate predict sentinel lymph node metastasis or survival in patients with intermediate and thick melanoma? Am J Surg. 2010;200:759–64.PubMedCrossRef
6.
De Vries M, Speijers MJ, Bastiaannet E, 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
7.
Doting MH, Hoekstra HJ, Plukker JT, et al. Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma. Eur J Surg Oncol. 2002;28:673–8.PubMedCrossRef
8.
McGovern VJ, Cochran AJ, Van der Esch EP et al. The classification of malignant melanoma, its histological reporting, and registration: a revision of the 1972 Sydney classification. Pathology. 1986;18:12–21.PubMedCrossRef
9.
Francken AB, Shaw HM, Thompson JF, et al. The prognostic importance of tumor mitotic rate confirmed in 1,317 patients with primary cutaneous melanoma and long follow-up. Ann Surg Oncol. 2004;11:426–33.PubMedCrossRef
10.
Azzola MF, Shaw HM, Thompson JF, et al. Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of 3,661 patients from a single center. Cancer. 2003;97:1488–98.PubMedCrossRef
11.
Van Akkooi ACJ, de Wilt JHw, Verhoef C, et al. High positive sentinel identification rate by EORTC Melanoma Group Protocol: prognostic indicators of metastatic patterns after sentinel node biopsy in melanoma. Eur J Cancer. 2006;42:372–80.PubMedCrossRef
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;17:976–83.PubMed
13.
White RL, Ayers GD, Stell VH, et al. Factors predictive of the status of sentinel lymph nodes in melanoma patients from a large multicenter database. Ann Surg Oncol. 2011;18: 3593–600.PubMedCentralPubMedCrossRef
14.
Kruper LL, Spitz FR, Czerniekcki BJ, et al. Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma. Cancer. 2006;107:2436–45.PubMedCrossRef
15.
Mocellin S, Ambrosi A, Montesco MC, et al. Support vector machine learning model for the prediction of sentinel node status in patients with cutaneous melanoma. Ann Surg Oncol. 2006;13:1113–22.PubMedCrossRef
16.
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.PubMedCentralPubMedCrossRef
17.
Fairbairn NG, Orfaniotis G, Butterworth M. Sentinel lymph node biopsy in thick malignant melanoma: a 10-year single-unit experience. J Plast Reconstr Aesthet Surg. 2012;65:1396–402.PubMedCrossRef
18.
Karakousis GC, Gimotty PA, Botbyl JD, et al. Predictors of regional nodal disease in patients with thin melanomas. Ann Surg Oncol. 2006;13:533–41.PubMedCrossRef
19.
Attis MG, Vollmer RT. Mitotic rate in melanoma: a reexamination. Am J Clin Pathol. 2007;127:380–4.PubMedCrossRef
20.
Ostmeier H, Fuchs B, Otto F, et al. Can immunohistochemical markers and mitotic rate improve prognostic precision in patients with primary melanoma? Cancer. 1999;85:2391–9.PubMedCrossRef
21.
Schmid-Wendtner MH, Baumert J, Schmidt M, et al. Prognostic index for cutaneous melanoma: an analysis after follow-up of 2,715 patients. Melanoma Res. 2001;11:619–26.PubMedCrossRef
22.
Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Coit DG, Atkins MB, et al. Age as a prognostic factor in patients with localized melanoma and regional metastases. Ann Surg Oncol. 2013;20:3961–8.PubMedCentralPubMedCrossRef
23.
Stucky CCH, Gray RJ, Dueck AC, et al. Risk factors associated with local in-transit recurrence of cutaneous melanoma. Am J Surg. 2010;200:770–5.PubMedCrossRef
24.
Scolyer RA, Shaw HM, Thompson JF, et al. Interobserver reproducibility of histopathologic prognostic variables in primary melanoma. Am J Surg Pathol. 2003;27:1571–6.PubMedCrossRef
25.
Balch CM, Gerschenwald JE, Soong SJ, Thompson JF, Ding S, et al. Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma: compariscon of nodal micrometastases versus macrometastases. J Clin Oncol. 2010;28:2452–9.PubMedCentralPubMedCrossRef
Metadata
Title
Tumor Mitotic Rate Added to the Equation: Melanoma Prognostic Factors Changed?
A Single-Institution Database Study on the Prognostic Value of Tumor Mitotic Rate for Sentinel Lymph Node Status and Survival of Cutaneous Melanoma Patients
Authors
M. J. Speijers, MD
E. Bastiaannet, PhD
S. Sloot, MD
A. J. H. Suurmeijer, MD, PhD
H. J. Hoekstra, MD, PhD
Publication date
01-09-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4349-3

Other articles of this Issue 9/2015

Annals of Surgical Oncology 9/2015 Go to the issue

Colorectal Cancer

Medullary Colorectal Carcinoma Revisited: A Clinical and Pathological Study of 102 Cases

Bone and Soft Tissue Sarcomas

Retroperitoneal Sarcoma (RPS) High Risk Gross Tumor Volume Boost (HR GTV Boost) Contour Delineation Agreement Among NRG Sarcoma Radiation and Surgical Oncologists

Bone and Soft Tissue Sarcomas

The Use of Radiation Therapy in Localized High-Grade Soft Tissue Sarcoma and Potential Impact on Survival

Bone and Soft Tissue Sarcomas

Surgical Downstaging in an Open-Label Phase II Trial of Denosumab in Patients with Giant Cell Tumor of Bone

Breast Oncology

Bilateral Risk-Reduction Mastectomy in BRCA1 and BRCA2 Mutation Carriers: A Meta-analysis

Head and Neck Oncology

Retropharyngeal Lymph Node Metastasis in 54 Patients with Oropharyngeal Squamous Cell Carcinoma Who Underwent Surgery-Based Treatment