Eduardo Bertolli1,2, Viola Franke3, Vinicius Fernando Calsavara4, Mariana Petaccia de Macedo5, Clovis Antonio Lopes Pinto5, Winan J van Houdt3, Michel W J M Wouters3, Joao Pedreira Duprat Neto6, Alexander C J van Akkooi3. 1. Skin Cancer Department, AC Camargo Cancer Center, São Paulo, SP, Brazil. ebertolli@hotmail.com. 2. Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. ebertolli@hotmail.com. 3. Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 4. Epidemiology and Statistics Department, AC Camargo Cancer Center, São Paulo, SP, Brazil. 5. Department of Pathology, AC Camargo Cancer Center, São Paulo, SP, Brazil. 6. Skin Cancer Department, AC Camargo Cancer Center, São Paulo, SP, Brazil.
Abstract
BACKGROUND: Non-sentinel node (NSN) positivity impacts the prognosis of melanoma patients; however, the benefits of completion lymph node dissection in patients with positive sentinel nodes (SNs) are limited. OBJECTIVE: We aimed to present a predictive nomogram for NSN positivity in melanoma patients with a positive SN biopsy. METHODS: This retrospective analysis from patients who underwent SN biopsy in a Brazilian institution from 2000 to 2015 was used for the construction and internal validation of the nomogram. This nomogram was then externally validated in a cohort of Dutch patients. RESULTS: The Brazilian cohort comprised 1213 patients, with a mean follow-up of 5.11 years. Breslow thickness (odds ratio [OR] 1.170, 95% confidence interval [CI] 1.043-1.314]; p = 0.008), number of positive SNs (OR 1.092, 95% CI 1.034-1.153; p = 0.001), and largest diameter of the metastatic deposit (OR 3.217, 95% CI 1.551-6.674; p = 0.002) were statistically significant for NSN positivity. Internal validation was performed using a bootstrapping technique. A good performance was observed (Brier score 0.097) and an excellent power of discrimination was achieved (area under the curve [AUC] 0.822). The nomogram was then applied to the Dutch cohort, and its overall performance (Brier score 0.085), calibration (Hosmer-Lemeshow goodness-of-fit test; p = 0.198), and discriminatory power (AUC 0.752, 95% CI 0.615-0.890) were all adequate. CONCLUSIONS: We presented a nomogram for assessing NSN probability that should not only be used for surgical considerations but also for risk stratification and clinical decisions. Internal validation has shown that this is an adequate model, while external validation increases the model's reliability and suggests that it can be globally incorporated.
BACKGROUND: Non-sentinel node (NSN) positivity impacts the prognosis of melanomapatients; however, the benefits of completion lymph node dissection in patients with positive sentinel nodes (SNs) are limited. OBJECTIVE: We aimed to present a predictive nomogram for NSN positivity in melanomapatients with a positive SN biopsy. METHODS: This retrospective analysis from patients who underwent SN biopsy in a Brazilian institution from 2000 to 2015 was used for the construction and internal validation of the nomogram. This nomogram was then externally validated in a cohort of Dutch patients. RESULTS: The Brazilian cohort comprised 1213 patients, with a mean follow-up of 5.11 years. Breslow thickness (odds ratio [OR] 1.170, 95% confidence interval [CI] 1.043-1.314]; p = 0.008), number of positive SNs (OR 1.092, 95% CI 1.034-1.153; p = 0.001), and largest diameter of the metastatic deposit (OR 3.217, 95% CI 1.551-6.674; p = 0.002) were statistically significant for NSN positivity. Internal validation was performed using a bootstrapping technique. A good performance was observed (Brier score 0.097) and an excellent power of discrimination was achieved (area under the curve [AUC] 0.822). The nomogram was then applied to the Dutch cohort, and its overall performance (Brier score 0.085), calibration (Hosmer-Lemeshow goodness-of-fit test; p = 0.198), and discriminatory power (AUC 0.752, 95% CI 0.615-0.890) were all adequate. CONCLUSIONS: We presented a nomogram for assessing NSN probability that should not only be used for surgical considerations but also for risk stratification and clinical decisions. Internal validation has shown that this is an adequate model, while external validation increases the model's reliability and suggests that it can be globally incorporated.
Authors: Jane Yuet Ching Hui; Erin Burke; Kristy K Broman; Schelomo Marmor; Eric Jensen; Todd M Tuttle; Jonathan S Zager Journal: J Surg Oncol Date: 2020-12-01 Impact factor: 3.454
Authors: Kristy K Broman; Tasha M Hughes; Lesly A Dossett; James Sun; Michael J Carr; Dennis A Kirichenko; Avinash Sharma; Edmund K Bartlett; Amanda Ag Nijhuis; John F Thompson; Tina J Hieken; Lisa Kottschade; Jennifer Downs; David E Gyorki; Emma Stahlie; Alexander van Akkooi; David W Ollila; Jill Frank; Yun Song; Giorgos Karakousis; Marc Moncrieff; Jenny Nobes; John Vetto; Dale Han; Jeffrey Farma; Jeremiah L Deneve; Martin D Fleming; Matthew Perez; Kirsten Baecher; Michael Lowe; Roger Olofsson Bagge; Jan Mattsson; Ann Y Lee; Russell S Berman; Harvey Chai; Hidde M Kroon; Roland M Teras; Juri Teras; Norma E Farrow; Georgia M Beasley; Jane Yc Hui; Lukas Been; Schelto Kruijff; David Boulware; Amod A Sarnaik; Vernon K Sondak; Jonathan S Zager Journal: J Am Coll Surg Date: 2020-12-13 Impact factor: 6.532
Authors: Amanda Zorzetto Antonialli; Eduardo Bertolli; Mariana Petaccia de Macedo; Clovis Antonio Lopes Pinto; Vinicius Fernando Calsavara; João Pedreira Duprat Neto Journal: An Bras Dermatol Date: 2020-09-18 Impact factor: 1.896