Prognostic Significance of a Positive Nonsentinel Lymph Node in Cutaneous Melanoma
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Sentinel lymph node (SLN) biopsy provides important prognostic information for patients with cutaneous melanoma. There may be additional prognostic significance to melanoma spreading from the SLN to nonsentinel lymph nodes (NSLN). We examined the implications of a positive NSLN for overall and distant disease-free survival.
Using a prospectively maintained, Institutional Review Board-approved melanoma database we studied patients who had a cutaneous melanoma, a positive SLN, and a completion lymph node dissection (CLND). Survival was determined using a combination of hospital records and the Social Security Death Index (SSDI). Univariate and multivariate Cox regression analysis was performed to further characterize predictors of overall and distant disease-free survival. Kaplan–Meier analysis was used to generate survival curves.
A total of 429 patients with positive SLN biopsies were identified, with at least one positive NSLN identified in 71 (17%). Median follow-up time was 36.8 months. Presence of a positive NSLN was significantly associated with poor outcome, although long-term survival was possible. Presence of ulceration, high mitotic rate, angiolymphatic invasion, total number of positive nodes, and volume of disease >1% in the SLN were significant predictors of survival on univariate analysis, but lost significance on multivariate. Multivariate Cox analysis revealed several predictors of overall survival: increasing age [hazard ratio (HR) 1.04, P < 0.01], Breslow depth (HR 1.76, P < 0.01), presence of extracapsular extension in the SLN (HR 2.39, P < 0.01), and positive NSLN (HR 1.92, P < 0.01).
Among node-positive melanoma patients, presence of a positive NSLN is a highly significant poor prognostic sign, even after considering the total number of positive nodes and volume of disease in the SLN. CLND after a positive SLN provides this important prognostic information.
- Gershenwald JE, Andtbacka RH, Prieto VG, et al. Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol. 2008;26(26):4296–303. CrossRef
- Sabel MS, Griffith KA, Arora A, et al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007;141:728–35. CrossRef
- Beitsch PD, Balch CM. Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection. Am J Surg. 1992;164:462–6. CrossRef
- Ingvar C, Erichsen C, Johnsson PE. Morbidity following prophylactic and therapeutic lymph node dissection for melanoma—A comparison. Tumori. 1984;70:529–33.
- Bowsher WG, Taylor BA, Hughes LE. Morbidity, mortality and local recurrence following regional node dissection for melanoma. Br J Surg. 1986;73:906–8. CrossRef
- Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17. CrossRef
- Guggenheim MM, Hug U, Jung FJ, et al. Morbidity and recurrence after completion lymph node dissection following sentinel lymph node biopsy in cutaneous malignant melanoma. Ann Surg. 2008;247(4):687–93. CrossRef
- Elias N, Tanabe KK, Sober AJ, et al. Is completion lymphadenectomy after a positive sentinel lymph node biopsy for cutaneous melanoma always necessary? Arch Surg. 2004;139(4):400–4 (discussion 404–5). CrossRef
- Carlson GW, Murray DR, Lyles RH, et al. The amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance? Ann Surg Oncol. 2003;10(5):575–81. CrossRef
- Cochran AJ, Wen DR, Huang RR, et al. Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol. 2004;17(7):747–55. CrossRef
- Debarbieux S, Duru G, Dalle S, et al. Sentinel lymph node biopsy in melanoma: a micromorphometric study relating to prognosis and completion lymph node dissection. Br J Dermatol. 2007;157(1):58–67. CrossRef
- 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(3):976–83.
- Lee JH, Essner R, Torisu-Itakura H, et al. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma. J Clin Oncol. 2004;22(18):3677–84. CrossRef
- McMasters KM, Wong SL, Edwards MJ, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol. 2002;9(2):137–41. CrossRef
- Page AJ, Carlson GW, Delman KA, et al. Prediction of nonsentinel lymph node involvement in patients with a positive sentinel lymph node in malignant melanoma. Am Surg. 2007;73(7):674–8 (discussion 678–9).
- Reeves ME, Delgado R, Busam KJ, et al. Prediction of nonsentinel lymph node status in melanoma. Ann Surg Oncol. 2003;10(1):27–31. CrossRef
- Sabel MS, Griffith K, Sondak VK, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg. 2005;201(1):37–47. CrossRef
- Wong SL, Morton DL, Thompson JF, et al. Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol. 2006;13(6):809–16. CrossRef
- Frankel TL, Griffith KA, Lowe L, et al. Do micromorphometric features of metastatic deposits within sentinel nodes predict nonsentinel lymph node involvement in melanoma? Ann Surg Oncol. 2008;15(9):2403–11. CrossRef
- Glumac N, Hocevar M, Zadnik V, Snoj M. Sentinel lymph node micrometastasis may predict non-sentinel involvement in cutaneous melanoma patients. J Surg Oncol. 2008;98(1):46–8. CrossRef
- 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(12):1922–8. CrossRef
- Roka F, Mastan P, Binder M, et al. Prediction of non-sentinel node status and outcome in sentinel node-positive melanoma patients. Eur J Surg Oncol. 2008;34(1):82–8.
- Rossi CR, De Salvo GL, Bonandini E, et al. Factors predictive of nonsentinel lymph node involvement and clinical outcome in melanoma patients with metastatic sentinel lymph node. Ann Surg Oncol. 2008;15(4):1202–10. CrossRef
- Satzger I, Volker B, Meier A, et al. Criteria in sentinel lymph nodes of melanoma patients that predict involvement of nonsentinel lymph nodes. Ann Surg Oncol. 2008;15(6):1723–32. CrossRef
- Ariyan C, Brady MS, Gonen M, et al. Positive nonsentinel node status predicts mortality in patients with cutaneous melanoma. Ann Surg Oncol. 2008;16:186–90. CrossRef
- 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(27):4464–71. CrossRef
- Torisu-Itakura H, Lee JH, Scheri RP, et al. Molecular characterization of inflammatory genes in sentinel and nonsentinel nodes in melanoma. Clin Cancer Res. 2007;13(11):3125–32. CrossRef
- Prognostic Significance of a Positive Nonsentinel Lymph Node in Cutaneous Melanoma
Annals of Surgical Oncology
Volume 16, Issue 11 , pp 2978-2984
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- 1. Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
- 2. Department of Dermatology, University of Michigan Health System, Ann Arbor, MI, USA
- 3. Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
- 4. Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI, USA