Danielle M Bello1, Gang Han2, Laura Jackson3, Kaleigh Bulloch3, Stephan Ariyan4, Deepak Narayan4, Bonnie Gould Rothberg3, Dale Han5. 1. Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. 2. Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA. 3. Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. 4. Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. 5. Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. dale.han@yale.edu.
Abstract
BACKGROUND: Sentinel lymph node biopsy (SLNB) is recommended for patients with intermediate-thickness melanoma, but the use of SLNB for patients with thick melanoma is debated. This report presents a single-institution study investigating factors predictive of sentinel lymph node (SLN) metastasis and outcome for thick-melanoma patients . METHODS: A retrospective review of a single-institution database from 1997 to 2012 identified 147 patients with thick primary cutaneous melanoma (≥4 mm) who had an SLNB. Clinicopathologic characteristics were correlated with nodal status and outcome. RESULTS: The median age of the patients was 67 years, and 61.9 % of the patients were men. The median tumor thickness was 5.5 mm, and 54 patients (36.7 %) had a positive SLN. Multivariable analysis showed that only tumor thickness significantly predicted SLN metastasis (odds ratio 1.14; 95 % confidence interval (CI) 1.02-1.28; P = 0.02). The overall median follow-up period was 34.6 months. Overall survival (OS) and melanoma-specific survival (MSS) were significantly worse for the positive versus negative-SLN patients. Multivariable analysis showed that age [hazard ratio (HR) 1.04; 95 % CI 1.01-1.07; P = 0.02] and SLN status (HR 2.24; 95 % CI 1.03-4.88; P = 0.04) significantly predicted OS, whereas only SLN status (HR 3.85; 95 % CI 2.13-6.97; P < 0.01) significantly predicted MSS. CONCLUSIONS: Tumor thickness predicts SLN status in thick melanomas. Furthermore, SLN status is prognostic for OS and MSS in thick-melanoma patients, with positive-SLN patients having significantly worse OS and MSS. These findings show that SLNB should be recommended for thick-melanoma patients, particularly because detection of SLN metastasis can identify patients for potential systemic therapy and treatment of nodal disease at a microscopic stage.
BACKGROUND: Sentinel lymph node biopsy (SLNB) is recommended for patients with intermediate-thickness melanoma, but the use of SLNB for patients with thick melanoma is debated. This report presents a single-institution study investigating factors predictive of sentinel lymph node (SLN) metastasis and outcome for thick-melanomapatients . METHODS: A retrospective review of a single-institution database from 1997 to 2012 identified 147 patients with thick primary cutaneous melanoma (≥4 mm) who had an SLNB. Clinicopathologic characteristics were correlated with nodal status and outcome. RESULTS: The median age of the patients was 67 years, and 61.9 % of the patients were men. The median tumor thickness was 5.5 mm, and 54 patients (36.7 %) had a positive SLN. Multivariable analysis showed that only tumor thickness significantly predicted SLN metastasis (odds ratio 1.14; 95 % confidence interval (CI) 1.02-1.28; P = 0.02). The overall median follow-up period was 34.6 months. Overall survival (OS) and melanoma-specific survival (MSS) were significantly worse for the positive versus negative-SLN patients. Multivariable analysis showed that age [hazard ratio (HR) 1.04; 95 % CI 1.01-1.07; P = 0.02] and SLN status (HR 2.24; 95 % CI 1.03-4.88; P = 0.04) significantly predicted OS, whereas only SLN status (HR 3.85; 95 % CI 2.13-6.97; P < 0.01) significantly predicted MSS. CONCLUSIONS:Tumor thickness predicts SLN status in thick melanomas. Furthermore, SLN status is prognostic for OS and MSS in thick-melanomapatients, with positive-SLN patients having significantly worse OS and MSS. These findings show that SLNB should be recommended for thick-melanomapatients, particularly because detection of SLN metastasis can identify patients for potential systemic therapy and treatment of nodal disease at a microscopic stage.
Authors: Dale Han; Gang Han; Monica T Duque; Steven Morrison; Stanley P Leong; Mohammed Kashani-Sabet; John Vetto; Richard White; Schlomo Schneebaum; Barbara Pockaj; Nicola Mozzillo; Vernon K Sondak; Jonathan S Zager Journal: Ann Surg Oncol Date: 2020-06-10 Impact factor: 5.344
Authors: E Rodríguez-Lomba; I Marquez-Rodas; E Mercader-Cidoncha; R Suárez-Fernández; J A Avilés-Izquierdo Journal: Clin Transl Oncol Date: 2017-03-01 Impact factor: 3.405
Authors: Yun Song; Feredun S Azari; Rebecca Tang; Adrienne B Shannon; John T Miura; Douglas L Fraker; Giorgos C Karakousis Journal: Ann Surg Oncol Date: 2020-05-13 Impact factor: 4.339