N Mozzillo1, S Pasquali2, M Santinami3, A Testori4, M Di Marzo1, A Crispo5, R Patuzzo3, F Verrecchia4, G Botti6, M Montella5, C R Rossi2, C Caracò7. 1. Dipartimento Melanoma, Istituto Nazione Tumori "Fondazione Pascale", Napoli, Italy. 2. Divisione Melanoma e Sarcomi, Istituto Oncologico Veneto, Padova, Italy. 3. Divisione Melanoma e Sarcomi, Istituto Nazionale Tumori, Milano, Italy. 4. Divisione Melanoma, Istituto Oncologico Europeo, Milano, Italy. 5. Divisione di Epidemiologia, Istituto Nazione Tumori "Fondazione Pascale", Napoli, Italy. 6. Divisione di Anatomia Patologica, Istituto Nazione Tumori "Fondazione Pascale", Napoli, Italy. 7. Dipartimento Melanoma, Istituto Nazione Tumori "Fondazione Pascale", Napoli, Italy. Electronic address: corracara@fastwebnet.it.
Abstract
INTRODUCTION: The optimal extent of the groin lymph node (LN) dissection for melanoma patients with positive sentinel LN biopsy is still debated and no agreement exist on dissection of pelvic LN. This study aimed at investigating predictors of pelvic LN metastasis and prognostic significance of having metastasis in the pelvic LNs. METHODS: Clinicopathologic data of 740 patients with positive groin sentinel LN who underwent ilioinguinal completion LN dissection at four Italian centre were analysed. Multivariable logistic and Cox regression analysis was used to identify independent predictors of pelvic LN metastasis and to adjust prognostic significance of pelvic LN metastasis. RESULTS: More than a quarter (26%) of patients had positive non-SLNs after inguinal and pelvic lymphadenectomy, which were located in their pelvis in the 12% of cases. Older patients [(OR) 1.69; 95% confidence interval (CI) 1.02-2.78] having thick primary (OR 1.6; 95% CI, 1.01-2.53) and ≥ 2 positive SLNs (OR 2.5; 95% CI, 1.4-4.47) were more likely to harbour pelvic LN metastasis. Interestingly, 4% of all patients (34% of patients with positive pelvic LNs) had pelvic LN metastasis with negative inguinal LNs. Pelvic LN metastasis was independently associated with higher risk of recurrence and lower survival. 5-year disease free and overall survival was 30% and 50%, respectively, for patients with pelvic LN metastasis. CONCLUSIONS: Pelvic LNs are frequently positive after ilioinguinal lymphadenectomy and it should be considered for all patients, especially those who are older, have thick primary and ≥ 2 positive SLN. Patients with pelvic LN metastasis have worse prognosis.
INTRODUCTION: The optimal extent of the groin lymph node (LN) dissection for melanomapatients with positive sentinel LN biopsy is still debated and no agreement exist on dissection of pelvic LN. This study aimed at investigating predictors of pelvic LN metastasis and prognostic significance of having metastasis in the pelvic LNs. METHODS: Clinicopathologic data of 740 patients with positive groin sentinel LN who underwent ilioinguinal completion LN dissection at four Italian centre were analysed. Multivariable logistic and Cox regression analysis was used to identify independent predictors of pelvic LN metastasis and to adjust prognostic significance of pelvic LN metastasis. RESULTS: More than a quarter (26%) of patients had positive non-SLNs after inguinal and pelvic lymphadenectomy, which were located in their pelvis in the 12% of cases. Older patients [(OR) 1.69; 95% confidence interval (CI) 1.02-2.78] having thick primary (OR 1.6; 95% CI, 1.01-2.53) and ≥ 2 positive SLNs (OR 2.5; 95% CI, 1.4-4.47) were more likely to harbour pelvic LN metastasis. Interestingly, 4% of all patients (34% of patients with positive pelvic LNs) had pelvic LN metastasis with negative inguinal LNs. Pelvic LN metastasis was independently associated with higher risk of recurrence and lower survival. 5-year disease free and overall survival was 30% and 50%, respectively, for patients with pelvic LN metastasis. CONCLUSIONS: Pelvic LNs are frequently positive after ilioinguinal lymphadenectomy and it should be considered for all patients, especially those who are older, have thick primary and ≥ 2 positive SLN. Patients with pelvic LN metastasis have worse prognosis.
Authors: John T Miura; Lesly A Dossett; Ram Thapa; Youngchul Kim; Aishwarya Potdar; Hala Daou; James Sun; Amod A Sarnaik; Jonathan S Zager Journal: Ann Surg Oncol Date: 2019-04-04 Impact factor: 5.344
Authors: Lesly A Dossett; Nicholas B Castner; Julio M Pow-Sang; Andrea M Abbott; Vernon K Sondak; Amod A Sarnaik; Jonathan S Zager Journal: J Am Coll Surg Date: 2016-01-14 Impact factor: 6.113
Authors: D Verver; M F Madu; C M C Oude Ophuis; M Faut; J H W de Wilt; J J Bonenkamp; D J Grünhagen; A C J van Akkooi; C Verhoef; B L van Leeuwen Journal: Br J Surg Date: 2017-11-02 Impact factor: 6.939
Authors: Mikko Vuoristo; Timo Muhonen; Virve Koljonen; Susanna Juteau; Micaela Hernberg; Suvi Ilmonen; Tiina Jahkola Journal: BJS Open Date: 2021-11-09