Prognosis of Patients with Melanoma and Microsatellitosis Undergoing Sentinel Lymph Node Biopsy
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Melanoma microsatellitosis is classified as stage IIIB/C disease and is associated with a poor prognosis. Prognostic factors within this group, however, have not been well characterized.
We performed a retrospective analysis of 1,621 patients undergoing sentinel lymph node (SLN) biopsy at our institution (1996–2011) to compare patients with (n = 98) and patients without (n = 1,523) microsatellites. Univariate and multivariate logistic and Cox regression analyses were used to identify factors associated with SLN positivity and melanoma-specific survival (MSS) in patients with microsatellites.
Patients with microsatellites were older and had lesions with higher Clark level and greater thickness that more frequently had mitoses, ulceration, and lymphovascular invasion (LVI) (all p < 0.0001). In microsatellite patients, the SLN positivity rate was 43 %. Lesional ulceration (odds ratio [OR] = 2.9, 95 % confidence interval [CI] 1.5–8.6), absent tumor infiltrating lymphocytes (OR = 2.8, 95 % CI 1.1–7.1), and LVI (OR = 3.3, 95 % CI 1.7–10) were significantly associated with SLN positivity by multivariate analysis. With a median follow-up of 4.5 years in survivors, ulceration (hazards ratio [HR] = 3.4, 95 % CI 1.5–7.8) and >1 metastatic LN (HR = 2.7, 95 % CI 1.1–6.6) were significantly associated with decreased MSS by multivariate analysis. In patients without these prognostic factors, the 5-year MSS was 90 % (n = 49) compared with 50 % (n = 23) among patients with ulceration only, 51 % (n = 12) in those with >1 metastatic LN only, or 25 % in those with both (n = 14, p < 0.01).
Microsatellitosis was frequently associated with multiple adverse pathologic features. In the absence of ulceration and >1 metastatic LN; however, the outcome for patients with microsatellites compared favorably to stage IIIB patients overall.
- Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206. CrossRef
- Balch CM, Gershenwald JE, Soong SJ, 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(14):2452–9. 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
- Hayes AJ, Clark MA, Harries M, Thomas JM. Management of in-transit metastases from cutaneous malignant melanoma. Br J Surg. 2004;91(6):673–82. CrossRef
- Murali R, Moncrieff MD, Hong J, 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(11):2992–9. CrossRef
- Wong JH, Cagle LA, Kopald KH, et al. Natural history and selective management of in transit melanoma. J Surg Oncol. 1990;44(3):146–50. CrossRef
- Edge SB, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th edn. Vol. XV, 2010.
- Day CL Jr, Harrist TJ, Gorstein F, et al. Malignant melanoma. Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg. 1981;194(1):108–12. CrossRef
- Leon P, Daly JM, Synnestvedt M, et al. The prognostic implications of microscopic satellites in patients with clinical stage I melanoma. Arch Surg. 1991;126(12):1461–8. CrossRef
- Nagore E, Oliver V, Botella-Estrada R, et al. Prognostic factors in localized invasive cutaneous melanoma: high value of mitotic rate, vascular invasion and microscopic satellitosis. Melanoma Res. 2005;15(3):169–77. CrossRef
- Rao UN, Ibrahim J, Flaherty LE, et al. Implications of microscopic satellites of the primary and extracapsular lymph node spread in patients with high-risk melanoma: pathologic corollary of Eastern Cooperative Oncology Group Trial E1690. J Clin Oncol. 2002;20(8):2053–7. CrossRef
- Shaikh L, Sagebiel RW, Ferreira CM, et al. The role of microsatellites as a prognostic factor in primary malignant melanoma. Arch Dermatol. 2005;141(6):739–42. CrossRef
- Azimi F, Scolyer RA, Rumcheva P, et al. Tumor-infiltrating lymphocyte grade is an independent predictor of sentinel lymph node status and survival in patients with cutaneous melanoma. J Clin Oncol. 2012;30(21):2678–83. CrossRef
- Buzaid AC, Ross MI, Balch CM, et al. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol. 1997;15(3):1039–51.
- Kimsey TF, Cohen T, Patel A, et al. Microscopic satellitosis in patients with primary cutaneous melanoma: implications for nodal basin staging. Ann Surg Oncol. 2009;16(5):1176–83. CrossRef
- Harrist TJ, Rigel DS, Day CL, Jr., et al. “Microscopic satellites” are more highly associated with regional lymph node metastases than is primary melanoma thickness. Cancer. 1984;53(10):2183–7. CrossRef
- Gimotty PA, Guerry D, Ming ME, et al. Thin primary cutaneous malignant melanoma: a prognostic tree for 10-year metastasis is more accurate than American Joint Committee on Cancer staging. J Clin Oncol. 2004;22(18):3668–76. CrossRef
- Kesmodel SB, Karakousis GC, Botbyl JD, et al. Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol. 2005;12(6):449–58. CrossRef
- Gordis L. Epidemiology. Saunders, Elsevier 2009.
- Rosner B. Fundamentals of biostatistics, 7th edn. Brooks/Cole Cengage Learning, 2011.
- Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer, 2001. CrossRef
- Juul SF. An introduction to Stata for health researchers. 3rd edn. StataCorp LP 2010; pp 179–96.
- Balch CM. Microscopic satellites around a primary melanoma: another piece of the puzzle in melanoma staging. Ann Surg Oncol. 2009;16(5):1092–4. CrossRef
- Balch CM, Soong S, Ross MI, et al. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial. Ann Surg Oncol. 2000;7(2):87–97. CrossRef
- Borgstein PJ, Meijer S, van Diest PJ. Are locoregional cutaneous metastases in melanoma predictable? Ann Surg Oncol. 1999;6(3):315–21. CrossRef
- Cascinelli N, Bufalino R, Marolda R, et al. Regional non-nodal metastases of cutaneous melanoma. Eur J Surg Oncol. 1986;12(2):175–80.
- Pawlik TM, Ross MI, Thompson JF, et al. The risk of in-transit melanoma metastasis depends on tumor biology and not the surgical approach to regional lymph nodes. J Clin Oncol. 2005;23(21):4588–90. CrossRef
- Weide B, Faller C, Buttner P, et al. Prognostic factors of melanoma patients with satellite or in-transit metastasis at the time of stage III diagnosis. PLoS One. 2013;8(4):e63137. CrossRef
- Prognosis of Patients with Melanoma and Microsatellitosis Undergoing Sentinel Lymph Node Biopsy
Annals of Surgical Oncology
Volume 21, Issue 3 , pp 1016-1023
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- 1. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- 2. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
- 3. Hematology-Oncology Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- 4. Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA