Melanomas

Annals of Surgical Oncology

, Volume 16, Issue 8, pp 2245-2251

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

  • James W. JakubAffiliated withDepartment of Surgery, Mayo Clinic Email author 
  • , Marianne HuebnerAffiliated withDepartment of Biostatistics, Mayo Clinic
  • , Steve ShiversAffiliated withDepartment of Surgical Oncology, Lakeland Regional Cancer Center
  • , Christopher NoboAffiliated withDepartment of Surgical Oncology, Lakeland Regional Cancer Center
  • , Christopher PuleoAffiliated withDepartment of Surgery, H. Lee Moffitt Cancer and Research Center
  • , William S. HarmsenAffiliated withDepartment of Biostatistics, Mayo Clinic
  • , Douglas S. ReintgenAffiliated withDepartment of Surgical Oncology, Lakeland Regional Cancer Center

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Abstract

Background

In melanoma, a direct relationship exists between the number of nodes involved with metastatic disease and prognosis. This study was undertaken to determine whether an individual with metastatic disease confined to the sentinel lymph nodes (SLNs) would have a better prognosis than individuals with metastatic disease that has spread to the non-SLNs, regardless of the number of nodes involved.

Methods

The study group consists of 229 melanoma patients with a positive SLN who underwent regional nodal dissection. Cox proportional hazard regression models were used to assess association of the number of SLNs and non-SLNs involved with disease with overall survival (OS) and disease-free survival (DFS).

Results

DFS and OS were unchanged regardless of how many SLNs were positive, as long as all disease was confined to SLNs. Among 183 patients without involvement of non-SLNs, OS remained the same despite an increasing number of SLNs involved (P = .59). This was true after controlling for ulceration, Breslow depth, age, sex, and adjuvant treatment. Once disease was present beyond the SLN, DFS and OS were negatively affected. Among patients with involvement of non-SLNs, there was no statistically significant association between the number of positive SLNs and survival. The risk of mortality increased with the number of non-SLNs involved with metastatic disease (P < .001).

Conclusions

The number of regional nodes involved with metastatic disease does not affect DFS and OS if disease is confined to the SLNs. Consideration should be given to specifying SLN versus non-SLN involvement in the American Joint Committee on Cancer staging manual.