Skip to main content

Advertisement

SpringerLink
Log in

Sentinel node tumor burden in cutaneous melanoma. Survival with competing risk analysis and influence in relapses and non-sentinel node status: retrospective cohort study with long follow-up in a Spanish population

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

A Correction to this article was published on 23 November 2021

This article has been updated

Abstract

Several authors have studied the potential of sentinel lymph node (SLN) tumor burden as prognostic factor but the microscopic classifications used in different study groups were variable. We examined the prognostic role of tumor burden in SLN on melanoma specific-survival and competing causes of death. We also analysed clinical and histological factors as predictors of disease relapses and additional non sentinel lymph node (NSLN) metastases. We included all patients with cutaneous melanoma that underwent SLN biopsy between 2002 and 2012 at Complejo Hospitalario de Navarra (Spain). The study end-points were death due to melanoma, melanoma relapse and involvement of NSLN. We used Fine-Gray test for competing risk analysis. A logistic regression model was performed to predict the risk of involvement of NSLN. Between 2002 and 2012, there were 348 patients who underwent SLN biopsy in our centre (308 were eligible for the study). 26.9% patients positive SLN. 88 patients died during the follow-up period and 66 (75%) died from melanoma. The 5-year cumulative incidence of melanoma death was 15.33% (95 % CI 15.25–15.42). The cumulative probability of death from melanoma was associated with gender, histological subtype, Breslow thickness, mitotic rate, ulceration and SLN tumor burden. In multivariable analysis, Breslow thickness and SLN tumor burden remained as independent prognostic factors. SLN tumor burden appears to be an important prognostic factor. It is very important reporting these characteristics in pathological reports. More prospective studies would be necessary to analyze these variables and to be able to make recommendations in management of melanoma patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

Not applicable.

Code availability

Not applicable.

Change history

References

  1. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF et al (2014) Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med 370:599–609

    Article  CAS  Google Scholar 

  2. Starz H, Siedlecki K, Balda B-R (2004) Sentinel lymphonodectomy and s-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol 11(3 Suppl):162S-S168

    Article  Google Scholar 

  3. Scolyer RA, Li L-XL, McCarthy SW, Shaw HM, Stretch JR, Sharma R et al (2004) Micromorphometric features of positive sentinel lymph nodes predict involvement of nonsentinel nodes in patients with melanoma. Am J Clin Pathol 122:532–539

    Article  Google Scholar 

  4. Dewar DJ, Newell B, Green MA, Topping AP, Powell BWEM, Cook MG (2004) The microanatomic location of metastatic melanoma in sentinel lymph nodes predicts nonsentinel lymph node involvement. J Clin Oncol 22:3345–3349

    Article  CAS  Google Scholar 

  5. Sabel MS, Griffith K, Sondak VK, Lowe L, Schwartz JL, Cimmino VM et al (2005) Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg 201:37–47

    Article  Google Scholar 

  6. van Akkooi ACJ, de Wilt JHW, Verhoef C, Schmitz PIM, van Geel AN, Eggermont AMM et al (2006) Clinical relevance of melanoma micrometastases (< 0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol 17:1578–1585

    Article  Google Scholar 

  7. Gershenwald JE, Andtbacka RHI, Prieto VG, Johnson MM, Diwan AH, Lee JE et al (2008) Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol 26:4296–4303

    Article  Google Scholar 

  8. Baehner FL, Li R, Jenkins T, Hwang J, Kashani-Sabet M, Allen RE et al (2012) The impact of primary melanoma thickness and microscopic tumor burden in sentinel lymph nodes on melanoma patient survival. Ann Surg Oncol 19:1034–1042

    Article  Google Scholar 

  9. van der Ploeg APT, van Akkooi ACJ, Rutkowski P, Nowecki ZI, Michej W, Mitra A et al (2011) Prognosis in patients with sentinel node-positive melanoma is accurately defined by the combined Rotterdam tumor load and Dewar topography criteria. J Clin Oncol 29:2206–2214

    Article  Google Scholar 

  10. van der Ploeg APT, van Akkooi ACJ, Haydu LE, Scolyer RA, Murali R, Verhoef C et al (2014) The prognostic significance of sentinel node tumour burden in melanoma patients: an international, multicenter study of 1539 sentinel node-positive melanoma patients. Eur J Cancer 50:111–120

    Article  Google Scholar 

  11. Kim C, Economou S, Amatruda TT, Martin JC, Dudek AZ (2015) Prognostic significance of microscopic tumor burden in sentinel lymph node in patients with cutaneous melanoma. Anticancer Res 35:301–309

    PubMed  Google Scholar 

  12. Kibrité A, Milot H, Douville P, Gagné ÉJ, Labonté S, Friede J et al (2016) Predictive factors for sentinel lymph nodes and non-sentinel lymph nodes metastatic involvement: a database study of 1,041 melanoma patients. Am J Surg 211:89–94

    Article  Google Scholar 

  13. Borgognoni L, Bellucci F, Urso C, Manneschi G, Gerlini G, Brandani P et al (2019) Enhancing the prognostic role of melanoma sentinel lymph nodes through microscopic tumour burden characterization: clinical usefulness in patients who do not undergo complete lymph node dissection. Melanoma Res 29:163–171

    Article  Google Scholar 

  14. Namikawa K, Aung PP, Milton DR, Tetzlaff MT, Torres-Cabala CA, Curry JL et al (2019) Correlation of tumor burden in sentinel lymph nodes with tumor burden in nonsentinel lymph nodes and survival in cutaneous melanoma. Clin Cancer Res 25:7585–7593

    Article  Google Scholar 

  15. Hoag JR, Hegde U, Zweifler R, Berwick M, Swede H (2016) Competing risks survival of older patients with metastatic cutaneous melanoma: a SEER population-based study. Melanoma Res 26:505–512

    Article  Google Scholar 

  16. Shen W, Sakamoto N, Yang L (2016) Melanoma-specific mortality and competing mortality in patients with non-metastatic malignant melanoma: a population-based analysis. BMC Cancer 16:413

    Article  Google Scholar 

  17. R: A language and environment for statistical computing. [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2013. http://www.R-project.org/

  18. Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C et al (2016) Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol 17:757–767

    Article  Google Scholar 

  19. Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS et al (2017) Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 376:2211–2222

    Article  Google Scholar 

  20. Wong SL, Faries MB, Kennedy EB, Agarwala SS, Akhurst TJ, Ariyan C et al (2018) Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update. J Clin Oncol 36:399–413

    Article  Google Scholar 

  21. van Akkooi ACJ, Spatz A (2009) Expert opinion in melanoma: The sentinel node; EORTC Melanoma Group recommendations on practical methodology of the measurement of the microanatomic location of metastases and metastatic tumour burden. Eur J Cancer 45:2736–2742

    Article  Google Scholar 

  22. Cook MG, Massi D, Szumera-Ciećkiewicz A, Van den Oord J, Blokx W, van Kempen LC et al (2019) An updated European Organisation for Research and Treatment of Cancer (EORTC) protocol for pathological evaluation of sentinel lymph nodes for melanoma. Eur J Cancer 114:1–7

    Article  Google Scholar 

  23. cp-skin-melanoma-17protocol-4010.pdf [Internet]. [cited 17 July 2020]. https://documents.cap.org/protocols/cp-skin-melanoma-17protocol-4010.pdf

  24. Berrocal A, Arance A, Castellon VE, de la Cruz L, Espinosa E, Cao MG et al (2018) SEOM clinical guideline for the management of malignant melanoma (2017). Clin Transl Oncol 20:69–74

    Article  CAS  Google Scholar 

  25. Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald J (2019) Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 80:208–250

    Article  Google Scholar 

  26. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al., editors. AJCC Cancer Staging Manual [Internet]. 8th ed. Springer International Publishing; 2017 [cited 2 december 2018]. www.springer.com/us/book/9783319406176

  27. Cutaneous_melanoma.pdf [Internet]. [cited 11 august 2020]. https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf

  28. Zhang Z, Cortese G, Combescure C, Marshall R, Lee M, Lim HJ et al (2018) Overview of model validation for survival regression model with competing risks using melanoma study data. Ann Transl Med 6:325

    Article  Google Scholar 

  29. Spanknebel K, Coit DG, Bieligk SC, Gonen M, Rosai J, Klimstra DS (2005) Characterization of micrometastatic disease in melanoma sentinel lymph nodes by enhanced pathology: recommendations for standardizing pathologic analysis. Am J Surg Pathol 29:305–317

    Article  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Dermatology Department of Complejo Hospitalario de Navarra, C/Irunlarrea., 31008, Pamplona, Navarra, Spain

    Leire Loidi-Pascual & Ignacio Yanguas

  2. Methodology Unit of Navarrabiomed Center-IDISNA, Pamplona, Spain

    Julián Librero

  3. Pathology Department of Complejo Hospitalario de Navarra, Pamplona, Spain

    Alicia Córdoba-Iturriagagoitia, Rosa Guarch-Troyas, Marta Montes-Díaz & Yerani Ruiz de Azua-Ciria

  4. Navarrabiomed, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

    Imanol Arozarena

  5. Nuclear Medicine Department of Complejo Hospitalario de Navarra, Pamplona, Spain

    Elena Goñi-Gironés

Authors
  1. Leire Loidi-Pascual
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julián Librero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alicia Córdoba-Iturriagagoitia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosa Guarch-Troyas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marta Montes-Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yerani Ruiz de Azua-Ciria
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Imanol Arozarena
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elena Goñi-Gironés
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ignacio Yanguas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leire Loidi-Pascual.

Ethics declarations

Conflicts of interest/competing interests

Not applicable.

Ethics approval

Ethical approval was obtained by the local institution´s human research committee (Pamplona, Spain). This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Consent to participate and publication

Informed consent was obtained from individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised to correct the given and family names of all the authors.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Loidi-Pascual, L., Librero, J., Córdoba-Iturriagagoitia, A. et al. Sentinel node tumor burden in cutaneous melanoma. Survival with competing risk analysis and influence in relapses and non-sentinel node status: retrospective cohort study with long follow-up in a Spanish population. Arch Dermatol Res 314, 369–378 (2022). https://doi.org/10.1007/s00403-021-02232-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-021-02232-z

Keywords

Search

Navigation