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Prognostic Role of Multiple Lymphatic Basin Drainage in Sentinel Lymph Node-Negative Trunk Melanoma Patients: A Multicenter Study from the Italian Melanoma Intergroup

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

Abstract

Background

Multiple lymphatic basin drainage (MLBD) is frequently observed in patients with trunk melanoma undergoing sentinel lymph node (SLN) biopsy. Conflicting data regarding the prognostic association of MLBD in SLN-negative patients have been reported. This study aimed to investigate the prognostic role of MLBD in patients with negative SLN biopsy.

Methods

Retrospective data from 656 melanoma patients who underwent a SLN biopsy (1991–2012) at six Italian centers were gathered in a multicenter database. MLBD was defined as lymphoscintigraphic and intraoperative identification of an SLN in more than one nodal basin. Clinical and pathologic variables were recorded and analyzed for their impact on survival.

Results

SLN-negative patients with MLBD were at lower risk of melanoma recurrence [hazard ratio (HR) 0.73, P = 0.05) and melanoma-related death (HR 0.68, P = 0.001) independent of common staging features. Multivariable Cox analyses of disease-free interval (DFI) and disease-specific survival (DSS) showed that MLBD maintained a favorable role and ulceration an unfavorable role. Histologic regression was independently associated only with DFI. When survival was stratified according to presence of MLBD, histologic regression and Breslow thickness <2 mm were associated with improved DFI (5-year DFI: 96.9 vs. 66,1 %, respectively; HR 0.48, P < 0.001) and DSS (5-year DSS: 96.7 vs. 71.8 %, respectively; HR 0.52, P = 0.005) compared to patients without these three favorable parameters.

Conclusions

Patients with negative SLN biopsy results have better prognosis when two or more lymphatic basins are identified and analyzed. Further research is required to investigate the mechanisms behind this evidence.

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Acknowledgments

The authors thank Benjamin Eveslage for language revision.

Author information

Author notes

    Authors and Affiliations

    1. Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy

      Simone Ribero MD, PhD, Simona Osella-Abate ScD & Pietro Quaglino MD

    2. Oncological Department, Dermatologic Surgery Department, Citta’ della Salute e della Scienza di Torino Hospital, Turin, Italy

      Simone Ribero MD, PhD & Giuseppe Macripò MD

    3. Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy

      Sandro Pasquali MD, Carlo Riccardo Rossi & Antonio Sommariva MD

    4. Department of Surgery, Oncology, and Gastroenterology, Surgery Branch, University of Padova, Padua, Italy

      Carlo Riccardo Rossi

    5. Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy

      Lorenzo Borgognoni MD, Paola Brandani MD & Francesco Bellucci MD

    6. Unit of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy

      Dario Piazzalunga MD & Luca Ansaloni MD

    7. Division of Surgical Oncology, IRCC-San Martino Hospital–National Cancer Institute of Genoa, Genoa, Italy

      Nicola Solari MD & Erica Ponte MD

    8. Plastic Surgery Department, Santa Maria della Misericordia di Udine Hospital, Udine, Italy

      Mauro Schiavon MD & Francesco Silan MD

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    Correspondence to Simone Ribero MD, PhD.

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    Simone Ribero and Simona Osella-Abate have contributed equally to this article.

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    Ribero, S., Osella-Abate, S., Pasquali, S. et al. Prognostic Role of Multiple Lymphatic Basin Drainage in Sentinel Lymph Node-Negative Trunk Melanoma Patients: A Multicenter Study from the Italian Melanoma Intergroup. Ann Surg Oncol 23, 1708–1715 (2016). https://doi.org/10.1245/s10434-015-4973-6

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