Simone Ribero1,2, Simona Osella-Abate3, Sandro Pasquali4, Carlo Riccardo Rossi4,5, Lorenzo Borgognoni6, Dario Piazzalunga7, Nicola Solari8, Mauro Schiavon9, Paola Brandani6, Luca Ansaloni7, Erica Ponte8, Francesco Silan9, Antonio Sommariva4, Francesco Bellucci6, Giuseppe Macripò10, Pietro Quaglino3. 1. Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy. simone.ribero@unito.it. 2. Oncological Department, Dermatologic Surgery Department, Citta' della Salute e della Scienza di Torino Hospital, Turin, Italy. simone.ribero@unito.it. 3. Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy. 4. Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy. 5. Department of Surgery, Oncology, and Gastroenterology, Surgery Branch, University of Padova, Padua, Italy. 6. Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy. 7. Unit of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy. 8. Division of Surgical Oncology, IRCC-San Martino Hospital-National Cancer Institute of Genoa, Genoa, Italy. 9. Plastic Surgery Department, Santa Maria della Misericordia di Udine Hospital, Udine, Italy. 10. Oncological Department, Dermatologic Surgery Department, Citta' della Salute e della Scienza di Torino Hospital, Turin, Italy.
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.
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 melanomapatients 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.
Authors: D Zugna; R Senetta; S Osella-Abate; M T Fierro; A Pisacane; A Zaccagna; A Sapino; V Bataille; A Maurichi; F Picciotto; P Cassoni; P Quaglino; S Ribero Journal: Br J Cancer Date: 2017-11-09 Impact factor: 7.640
Authors: Francisca Jácome Morgado; Paula Soeiro; Ana Brinca; André Pinho; Ricardo Vieira Journal: An Bras Dermatol Date: 2021-10-05 Impact factor: 1.896