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Prediction of Non-sentinel Node Status in Patients with Melanoma and Positive Sentinel Node Biopsy: An Italian Melanoma Intergroup (IMI) Study

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

Abstract

Background and Purpose

Approximately 20% of melanoma patients harbor metastases in non-sentinel nodes (NSNs) after a positive sentinel node biopsy (SNB), and recent evidence questions the therapeutic benefit of completion lymph node dissection (CLND). We built a nomogram for prediction of NSN status in melanoma patients with positive SNB.

Methods

Data on anthropometric and clinicopathological features of patients with cutaneous melanoma who underwent CLND after a positive SNB were collected from nine Italian centers. Multivariate logistic regression was utilized to identify predictors of NSN status in a training set, while model efficiency was validated in a validation set.

Results

Data were available for 1220 patients treated from 2000 through 2016. In the training set (n = 810), the risk of NSN involvement was higher when (1) the primary melanoma is thicker or (2) sited in the trunk/head and neck; (3) fewer nodes are excised and (4) more nodes are involved; and (5) the lymph node metastasis is larger or (6) is deeply located. The model showed high discrimination (area under the receiver operating characteristic curve 0.74, 95% confidence interval [CI] 0.70–0.79) and calibration (Brier score 0.16, 95% CI 0.15–0.17) performance in the validation set (n = 410). The nomogram including these six clinicopathological variables performed significantly better than five other previously published models in terms of both discrimination and calibration.

Conclusions

Our nomogram could be useful for follow-up personalization in clinical practice, and for patient risk stratification while conducting clinical trials or analyzing their results.

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Disclosure

Carlo Riccardo Rossi, Simone Mocellin, Luca Giovanni Campana, Lorenzo Borgognoni, Serena Sestini, Giuseppe Giudice, Corrado Caracò, Adriana Cordova, Nicola Solari, Dario Piazzalunga, Paolo Carcoforo, Pietro Quaglino, Virginia Caliendo, and Simone Ribero have declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Surgical Oncology Unit, IOV-IRCCS of Padova, Padua, Italy

    Carlo Riccardo Rossi MD, Simone Mocellin MD & Luca Giovanni Campana MD

  2. Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Padua, Italy

    Carlo Riccardo Rossi MD, Simone Mocellin MD & Luca Giovanni Campana MD

  3. Centro di Riferimento Regionale per il Melanoma, Ospedale S.M. Annunziata, Azienda USL Toscana Centro, Florence, Italy

    Lorenzo Borgognoni MD & Serena Sestini MD

  4. U.O.C. di Chirurgia Plastica Ricostruttiva e Centro Ustioni Policlinico, University of Bari, Bari, Italy

    Giuseppe Giudice MD

  5. Struttura Complessa Chirurgia Oncologica Melanoma – Istituto Nazionale Tumori Pascale, Napoles, Italy

    Corrado Caracò MD

  6. A.O.U.P. Paolo Giaccone, Dip. Discipline Chirurgiche, University of Palermo, Oncologiche e Stomatologiche – Sezione di Chirurgia Plastica, Palermo, Italy

    Adriana Cordova MD

  7. Chirurgia I – Ospedale San Martino, Genoa, Italy

    Nicola Solari MD

  8. Chirurgia Generale 1, Ospedale Papa Giovanni XXIII, Bergamo, Italy

    Dario Piazzalunga MD

  9. UOC Chirurgia II Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy

    Paolo Carcoforo MD

  10. Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy

    Pietro Quaglino MD & Simone Ribero MD

  11. Dermatologic Surgery Division, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy

    Virginia Caliendo MD & Simone Ribero MD

Authors
  1. Carlo Riccardo Rossi MD
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  2. Simone Mocellin MD
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  3. Luca Giovanni Campana MD
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  4. Lorenzo Borgognoni MD
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  5. Serena Sestini MD
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  6. Giuseppe Giudice MD
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  7. Corrado Caracò MD
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  8. Adriana Cordova MD
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  9. Nicola Solari MD
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  10. Dario Piazzalunga MD
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  11. Paolo Carcoforo MD
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  12. Pietro Quaglino MD
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  13. Virginia Caliendo MD
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  14. Simone Ribero MD
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Consortia

on behalf of the Italian Melanoma Intergroup (IMI)

Corresponding author

Correspondence to Simone Mocellin MD.

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Rossi, C.R., Mocellin, S., Campana, L.G. et al. Prediction of Non-sentinel Node Status in Patients with Melanoma and Positive Sentinel Node Biopsy: An Italian Melanoma Intergroup (IMI) Study. Ann Surg Oncol 25, 271–279 (2018). https://doi.org/10.1245/s10434-017-6143-5

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  • DOI: https://doi.org/10.1245/s10434-017-6143-5

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