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Diversity of Stage III Melanoma in the Era of Sentinel Lymph Node Biopsy

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node (SLN) biopsy for melanoma often detects minimal nodal tumor burden. Although all node-positive patients are considered stage III, there is controversy regarding the necessity of adjuvant therapy for all patients with tumor-positive SLN.

Methods

Post hoc analysis was performed of a prospective multi-institutional study of patients with melanoma ≥ 1.0 mm Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for patients with SLN metastasis. Kaplan–Meier analysis of disease-free survival (DFS) and overall survival (OS) was performed. Univariate and multivariate Cox regression analyses were performed. Classification and regression tree (CART) analysis also was performed.

Results

A total of 509 patients with tumor-positive SLN were evaluated. Independent risk factors for worse OS included thickness, age, gender, presence of ulceration, and tumor-positive non-SLN (nodal metastasis found on completion lymphadenectomy). As the number of tumor-positive SLN and the total number of tumor-positive nodes (SLN and non-SLN) increased, DFS and OS worsened on Kaplan–Meier analysis. On CART analysis, the 5-year OS rates ranged from 84.9 % (women with thickness < 2.1 mm, age < 59 years, no ulceration, and tumor-negative non-SLN) to 14.3 % (men with thickness ≥ 2.1 mm, age ≥ 59 years, ulceration present, and tumor-positive non-SLN). Six distinct subgroups were identified with 5-year OS in excess of 70 %.

Conclusions

Stage III melanoma in the era of SLN is associated with a very wide range of prognosis. CART analysis of prognostic factors allows discrimination of low-risk subgroups for which adjuvant therapy may not be warranted.

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Conflict of interest

This is a study of the Sunbelt Melanoma Trial, which was sponsored by a grant from Schering Oncology Biotech. All data management and subsequent analysis has been performed independently at the University of Louisville. Schering Oncology Biotech was not involved in conduct of the trial, data analysis, or production of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Louisville, Louisville, KY, USA

    Michael E. Egger MD, Glenda G. Callender MD, Kelly M. McMasters MD, PhD, Robert C. G. Martin II MD, PhD & Charles R. Scoggins MD, MBA

  2. University of Texas-MD Anderson Cancer Center, Houston, TX, USA

    Merrick I. Ross MD

  3. Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    Michael J. Edwards MD & Jeffrey J. Sussman MD

  4. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Marshall M. Urist MD

  5. Intermountain Medical Group, Murray, UT, USA

    R. Dirk Noyes MD

  6. Department of Surgery, University of South Florida, Tampa, FL, USA

    Douglas S. Reintgen MD

  7. Department of Statistics, University of Kentucky, Lexington, KY

    Arnold J. Stromberg PhD

Authors
  1. Michael E. Egger MD
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  2. Glenda G. Callender MD
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  3. Kelly M. McMasters MD, PhD
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  4. Merrick I. Ross MD
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  5. Robert C. G. Martin II MD, PhD
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  6. Michael J. Edwards MD
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  7. Marshall M. Urist MD
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  8. R. Dirk Noyes MD
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  9. Jeffrey J. Sussman MD
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  10. Douglas S. Reintgen MD
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  11. Arnold J. Stromberg PhD
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  12. Charles R. Scoggins MD, MBA
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Corresponding author

Correspondence to Charles R. Scoggins MD, MBA.

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Egger, M.E., Callender, G.G., McMasters, K.M. et al. Diversity of Stage III Melanoma in the Era of Sentinel Lymph Node Biopsy. Ann Surg Oncol 20, 956–963 (2013). https://doi.org/10.1245/s10434-012-2701-z

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  • DOI: https://doi.org/10.1245/s10434-012-2701-z

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