Skip to main content
SpringerLink
Log in

Outcome of Clinical Stage III Melanoma Patients with FDG-PET and Whole-Body CT Added to the Diagnostic Workup

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

Abstract

Background

Combined whole-body FDG-PET and CT provide the most comprehensive staging of melanoma patients with palpable lymph node metastases (LNM). The aim of this study is to analyze survival of FDG-PET and CT negative or positive melanoma patients and to assess which factors have independent prognostic impact on survival of these patients.

Methods

Patients with palpable and histologically or cytologically proven LNM of melanoma, referred to participating hospitals for examination with FDG-PET and CT, were selected from a previous study. Melanoma-specific survival (MSS) and disease-free period (DFP) were analyzed for FDG-PET and CT positive and negative patients using the Kaplan–Meier method. Cox-regression analysis was performed to analyze which patient or melanoma characteristics had significant impact on MSS or DFP.

Results

For all 252 patients 5-year MSS was 38.2 %. For FDG-PET and CT negative and positive patients 5-year MSS was 47.6 and 16.9 %, respectively. Disease-free period for FDG-PET and CT negative patients was 46.0 % after 5 years. Gender, a positive FDG-PET and CT, LNM in axilla compared to head or neck, and presence of extranodal growth were independent factors for worse MSS in all patients. Positive FDG-PET and CT was the most important prognostic factor for MSS with a hazard ratio of 2.54 (95 % CI, 1.55–4.17, P < 0.001).

Conclusions

Staging melanoma patients with palpable LNM is more accurate when whole-body FDG-PET and CT is added to the diagnostic workup. Hence, FDG-PET and CT, preferably combined, are indicated in the staging of clinical stage III 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

Similar content being viewed by others

References

  1. Dutch comprehensive cancer centers. 2012. http://ikcnet.nl/. Accessed January 2013.

  2. Kruijff S, Bastiaannet E, Francken AB, Schaapveld M, van der Aa M, Hoekstra HJ. Breslow thickness in the Netherlands: a population-based study of 40,880 patients comparing young and elderly patients. Br J Cancer. 2012;107:570–4.

    Article  PubMed  CAS  Google Scholar 

  3. Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol. 2005;6:608–21.

    Article  PubMed  Google Scholar 

  4. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.

    Article  PubMed  Google Scholar 

  5. Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 2012;30:2912–8.

    Article  PubMed  Google Scholar 

  6. Hughes TM, A’Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg. 2000;87:892–901.

    Article  PubMed  CAS  Google Scholar 

  7. van Akkooi AC, Bouwhuis MG, van Geel AN, Hoedemaker R, Verhoef C, Grunhagen DJ, et al. Morbidity and prognosis after therapeutic lymph node dissections for malignant melanoma. Eur J Surg Oncol. 2007;33:102–8.

    Article  PubMed  Google Scholar 

  8. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Ding S, Byrd DR, 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;28:2452–9.

    Article  PubMed  Google Scholar 

  9. Wevers KP, Bastiaannet E, Poos HP, van Ginkel RJ, Plukker JT, Hoekstra HJ. Therapeutic lymph node dissection in melanoma: different prognosis for different macrometastasis sites? Ann Surg Oncol. 2012;19:3913–8.

    Article  PubMed  CAS  Google Scholar 

  10. Romano E, Scordo M, Dusza SW, Coit DG, Chapman PB. Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol. 2010;28:3042–7.

    Article  PubMed  Google Scholar 

  11. Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg. 1995;181:193–201.

    PubMed  CAS  Google Scholar 

  12. Francken AB, Accortt NA, Shaw HM, Wiener M, Soong SJ, Hoekstra HJ, et al. Prognosis and determinants of outcome following locoregional or distant recurrence in patients with cutaneous melanoma. Ann Surg Oncol. 2008;15:1476–84.

    Article  PubMed  Google Scholar 

  13. Roses DF, Karp NS, Oratz R, Dubin N, Harris MN, Speyer J, et al. Survival with regional and distant metastases from cutaneous malignant melanoma. Surg Gynecol Obstet. 1991;172:262–8.

    PubMed  CAS  Google Scholar 

  14. Soong SJ, Harrison RA, McCarthy WH, Urist MM, Balch CM. Factors affecting survival following local, regional, or distant recurrence from localized melanoma. J Surg Oncol. 1998;67:228–33.

    Article  PubMed  CAS  Google Scholar 

  15. Howard JH, Thompson JF, Mozzillo N, Nieweg OE, Hoekstra HJ, Roses DF, et al. Metastasectomy for distant metastatic melanoma: analysis of data from the first multicenter selective lymphadenectomy trial (MSLT-I). Ann Surg Oncol. 2012;19:2547–55.

    Article  PubMed  Google Scholar 

  16. Ollila DW. Complete metastasectomy in patients with stage IV metastatic melanoma. Lancet Oncol. 2006;7:919–24.

    Article  PubMed  Google Scholar 

  17. Bastiaannet E, Wobbes T, Hoekstra OS, van der Jagt EJ, Brouwers AH, Koelemij R, et al. Prospective comparison of [18F]fluorodeoxyglucose positron emission tomography and computed tomography in patients with melanoma with palpable lymph node metastases: diagnostic accuracy and impact on treatment. J Clin Oncol. 2009;27:4774–80.

    Article  PubMed  Google Scholar 

  18. Flaherty KT, Infante JR, Daud A, Gonzalez R, Kefford RF, Sosman J, et al. Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med. 2012;367:1694–703.

    Article  PubMed  CAS  Google Scholar 

  19. Bastiaannet E, Oyen WJ, Meijer S, Hoekstra OS, Wobbes T, Jager PL, et al. Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients. Br J Surg. 2006;93:243–9.

    Article  PubMed  CAS  Google Scholar 

  20. Mohr P, Eggermont AM, Hauschild A, Buzaid A. Staging of cutaneous melanoma. Ann Oncol. 2009;20 Suppl 6:vi14–21.

    Article  PubMed  Google Scholar 

  21. Zukauskaite R, Schmidt H, Asmussen JT, Hansen O, Bastholt L. Asymptomatic brain metastases in patients with cutaneous metastatic malignant melanoma. Melanoma Res. 2013;23:21–6.

    Article  PubMed  CAS  Google Scholar 

  22. Aloia TA, Gershenwald JE, Andtbacka RH, Johnson MM, Schacherer CW, Ng CS, et al. Utility of computed tomography and magnetic resonance imaging staging before completion lymphadenectomy in patients with sentinel lymph node-positive melanoma. J Clin Oncol. 2006;24:2858–65.

    Article  PubMed  Google Scholar 

  23. Bastiaannet E, Uyl-de Groot CA, Brouwers AH, van der Jagt EJ, Hoekstra OS, Oyen W, et al. Cost-effectiveness of adding FDG-PET or CT to the diagnostic work-up of patients with stage III melanoma. Ann Surg. 2012;255:771–6.

    Article  PubMed  Google Scholar 

  24. Spatz A, Batist G, Eggermont AM. The biology behind prognostic factors of cutaneous melanoma. Curr Opin Oncol. 2010;22:163–8.

    Article  PubMed  CAS  Google Scholar 

  25. Joosse A, Collette S, Suciu S, Nijsten T, Lejeune F, Kleeberg UR, et al. Superior outcome of women with stage I/II cutaneous melanoma: pooled analysis of four European organisation for research and treatment of cancer phase III trials. J Clin Oncol. 2012;30:2240–7.

    Article  PubMed  Google Scholar 

  26. Burmeister BH, Smithers BM, Poulsen M, McLeod GR, Bryant G, Tripcony L, et al. Radiation therapy for nodal disease in malignant melanoma. World J Surg. 1995;19:369–71.

    Article  PubMed  CAS  Google Scholar 

  27. Corry J, Smith JG, Bishop M, Ainslie J. Nodal radiation therapy for metastatic melanoma. Int J Radiat Oncol Biol Phys. 1999;44:1065–9.

    Article  PubMed  CAS  Google Scholar 

  28. Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO melanoma programme. Lancet. 1998;351:793–6.

    Article  PubMed  CAS  Google Scholar 

  29. Debarbieux S, Duru G, Dalle S, Beatrix O, Balme B, Thomas L. Sentinel lymph node biopsy in melanoma: a micromorphometric study relating to prognosis and completion lymph node dissection. Br J Dermatol. 2007;157:58–67.

    Article  PubMed  CAS  Google Scholar 

  30. Francischetto T, Spector N, Neto Rezende JF, de Azevedo Antunes M, de Oliveira Romano S, Small IA, et al. Influence of sentinel lymph node tumor burden on survival in melanoma. Ann Surg Oncol. 2010;17:1152–8.

    Article  PubMed  Google Scholar 

  31. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.

    Article  PubMed  CAS  Google Scholar 

  32. Murali R, Desilva C, Thompson JF, Scolyer RA. Factors predicting recurrence and survival in sentinel lymph node-positive melanoma patients. Ann Surg. 2011;253:1155–64.

    Article  PubMed  Google Scholar 

  33. O’Brien CJ, Petersen-Schaefer K, Stevens GN, Bass PC, Tew P, Gebski VJ, et al. Adjuvant radiotherapy following neck dissection and parotidectomy for metastatic malignant melanoma. Head Neck. 1997;19:589–94.

    Article  PubMed  Google Scholar 

  34. Pearlman NW, McCarter MD, Frank M, Hurtubis C, Merkow RP, Franklin WA, et al. Size of sentinel node metastases predicts other nodal disease and survival in malignant melanoma. Am J Surg. 2006;192:878–81.

    Article  PubMed  Google Scholar 

  35. Scheri RP, Essner R, Turner RR, Ye X, Morton DL. Isolated tumor cells in the sentinel node affect long-term prognosis of patients with melanoma. Ann Surg Oncol. 2007;14:2861–6.

    Article  PubMed  Google Scholar 

  36. van Akkooi AC, Nowecki ZI, Voit C, Schäfer-Hesterberg G, Michej W, de Wilt JH, et al. Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg. 2008;248:949–55.

    Article  PubMed  Google Scholar 

  37. Wright EH, Stanley PR, Roy A. Evaluation of sentinel lymph nodes positive for melanoma for features predictive of non-sentinel nodal disease and patient prognosis: a 49 patient series. J Plast Reconstr Aesthet Surg. 2010;63:e500–2.

    Article  PubMed  CAS  Google Scholar 

  38. Kruijff S, Bastiaannet E, Suurmeijer AJ, Hoekstra HJ. Detection of melanoma nodal metastases; differences in detection between elderly and younger patients do not affect survival. Ann Surg Oncol. 2010;17:3008–14.

    Article  PubMed  CAS  Google Scholar 

  39. Jakub JW, Huebner M, Shivers S, Nobo C, Puleo C, Harmsen WS, et al. 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. Ann Surg Oncol. 2009;16:2245–51.

    Article  PubMed  Google Scholar 

  40. Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the surveillance, epidemiology, and end results (SEER) program. Arch Dermatol. 2008;144:515–21.

    Article  PubMed  Google Scholar 

  41. Prens SP, van der Ploeg AP, van Akkooi AC, van Montfort CA, van Geel AN, de Wilt JH, et al. Outcome after therapeutic lymph node dissection in patients with unknown primary melanoma site. Ann Surg Oncol. 2011;18:3586–92.

    Article  PubMed  Google Scholar 

  42. Cohn-Cedermark G, Mansson-Brahme E, Rutqvist LE, Larsson O, Singnomklao T, Ringborg U. Metastatic patterns, clinical outcome, and malignant phenotype in malignant cutaneous melanoma. Acta Oncol. 1999;38:549–57.

    Article  PubMed  CAS  Google Scholar 

  43. Hoyt DJ, Fisher SR. Survival following recurrent malignant melanoma of the head and neck. Laryngoscope. 1989;99:586–9.

    Article  PubMed  CAS  Google Scholar 

  44. Murali R, Moncrieff MD, Hong J, Cooper CL, Shingde MV, Samuel DG, et al. The prognostic value of tumor mitotic rate and other clinicopathologic factors in patients with locoregional recurrences of melanoma. Ann Surg Oncol. 2010;17:2992–9.

    Article  PubMed  Google Scholar 

  45. Soong SJ, Harrison RA, McCarthy WH, Urist MM, Balch CM. Factors affecting survival following local, regional, or distant recurrence from localized melanoma. J Surg Oncol. 1998;67:228–33.

    Article  PubMed  CAS  Google Scholar 

  46. Dong XD, Tyler D, Johnson JL, DeMatos P, Seigler HF. Analysis of prognosis and disease progression after local recurrence of melanoma. Cancer. 2000;88:1063–71.

    Article  PubMed  CAS  Google Scholar 

  47. White RR, Stanley WE, Johnson JL, Tyler DS, Seigler HF. Long-term survival in 2,505 patients with melanoma with regional lymph node metastasis. Ann Surg. 2002;235:879–87.

    Article  PubMed  Google Scholar 

  48. Fournier K, Xing Y, Ross M, Lee JE, Gershenwald JE, Mansfield PF, et al. Survival in patients with synchronous versus metachronous lymph node (LN) involvement in stage III melanoma: is there a difference? 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition). J Clin Oncol. 2008;26(No 15S):9034.

    Google Scholar 

Download references

Acknowledgment

The authors thank Dr. J.M.H. de Klerk (Nuclear Medicine at Meander Medical Centre Amersfoort) for the inclusion of the melanoma patients from this institution for this study.

Disclosures

The authors have no disclosures

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

    M. G. Niebling MD & H. J. Hoekstra PhD

  2. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands

    E. Bastiaannet PhD

  3. Department of Gerontology & Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands

    E. Bastiaannet PhD

  4. Department of Nuclear Medicine & PET Research, VU University Medical Centre, Amsterdam, The Netherlands

    O. S. Hoekstra PhD

  5. Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    J. J. Bonenkamp PhD

  6. Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands

    R. Koelemij PhD

Authors
  1. M. G. Niebling MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Bastiaannet PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. S. Hoekstra PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. J. Bonenkamp PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Koelemij PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. J. Hoekstra PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. J. Hoekstra PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Niebling, M.G., Bastiaannet, E., Hoekstra, O.S. et al. Outcome of Clinical Stage III Melanoma Patients with FDG-PET and Whole-Body CT Added to the Diagnostic Workup. Ann Surg Oncol 20, 3098–3105 (2013). https://doi.org/10.1245/s10434-013-2969-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-2969-7

Keywords

Search

Navigation