Clinical prognostic markers in stage IIIC melanoma

Madu, M.; Schopman, Jaap H.H.; Berger, Danique M.S.; Klop, W. Martin C.; Jóźwiak, Katarzyna; Wouters, Michel W. J. M.; Hage, Jos A. van der; Akkooi, Alexander C. J. van

doi:10.1002/jso.24635

Cited by 11 publications

(5 citation statements)

References 22 publications

(41 reference statements)

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“…(205,206) Further research has championed the value of LNR as an independent predictor of DFS and MSS in select groups of patients. (207,208) However, in this study the LNR was not significantly associated with MSS, unlike overall disease stage and regional lymph node positivity. On multivariate analysis lymph node involvement was the most powerful predictor of MSS (p = 0.012), followed by age >75 years (p = 0.069), more than ten lesions (p = 0.017) and head or neck location (p = 0.012).…”

Section: Nb Procedures Involving Selective Lymphadenectomy Including Sentinel Lymph Node Biopsy (Slnb)contrasting

confidence: 74%

An evaluation of the role of locoregional treatments for the management of in-transit melanoma metastases

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In-transit melanoma metastases are a well-recognised clinical phenomenon. The disease affects a heterogeneous group of patients and encompasses a broad phenotype. While frequently characterised by a recalcitrant pattern of disease progression, patients have a variable natural history. Locoregional recurrence has traditionally been considered to portend adverse survival. However, evidence suggests that a subset of patients experience prolonged disease-specific survival and instead, face challenges secondary to quality of life. These detrimental effects may be related to treatment or the disease. Moreover, the unpredictable clinical behaviour and need for less invasive and locally administered options has led to the development of numerous therapies. Recently, locoregional treatments have gained popularity as potentially efficacious alternatives with limited toxicity and morbidity profiles relative to more aggressive strategies.Despite the multitude of therapies reported in the literature, there remains a paucity of evidence concerning treatment selection and the long-term survival outcomes of patients within large, well-defined cohorts.Consequently, there is a lack of consensus governing the management of this disease. Additional data are required to characterise this cohort of patients and describe the therapeutic benefits of the various treatments available. Patient and disease factors that can be used to select therapy must also be identified.Further, with the earlier implementation of systemic agents for metastatic disease, the effects of novel immunotherapies and the continuing role for locoregional treatments within this group need to be clearly defined. Given the complexity in clinical decision making, this thesis seeks to concisely describe the outcomes of patients, in terms of locoregional treatment effects and survival, while identifying prognostic indicators that can be used to guide subsequent care.A structured, quantitative review of the literature was undertaken to appraise existing evidence for locoregional treatments in Australia. This was followed by a retrospective review of patients treated with this condition at a single institution. A series of studies were then performed to examine the use of PV-10, radiotherapy, isolated limb infusion, and diphenylcyclopropenone for the treatment of patients with in-transit disease. Next, a phase II, prospective, randomised, pilot study was established to compare two topical immunotherapeutic agents: imiquimod and diphenylcyclopropenone for the selective treatment of epidermotropic metastases. A case report is presented highlighting the benefit of a sequential, multimodal treatment strategy for the management of in-transit melanoma. Finally, a subgroup of patients was treated using systemic anti-PD-1 immunotherapy and an analysis was performed to characterise the role of such treatments within this cohort.The treatment of this disease has rapidly evolved with a transition from radical surgical intervention to more conservative measures. This contemporary app...

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Section: Nb Procedures Involving Selective Lymphadenectomy Including Sentinel Lymph Node Biopsy (Slnb)contrasting

confidence: 74%

An evaluation of the role of locoregional treatments for the management of in-transit melanoma metastases

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“…TLND is associated with significant morbidity and frequently does not result in cure, as 20-80% of patients progress to stage IV melanoma. 1,[3][4][5] During the past decade, there have been enormous improvements in systemic therapies, with safety and efficacy first demonstrated for patients with stage IV melanoma. Currently, widely available effective systemic therapy can be categorized into two groups: immune checkpoint blockade (ICB) and targeted therapy (TT).…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Systemic Therapy (NAST) in Patients with Melanoma: Surgical Considerations by the International Neoadjuvant Melanoma Consortium (INMC)

et al. 2022

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“…Our finding that extracapsular extension of lymph node metastases was not significantly associated with worse prognosis was only somewhat surprising. Although extracapsular extension seems to negatively influence outcome in breast cancer (15), malignant melanoma (16), and head and neck carcinoma (17) it currently has no place in the TNM classification for NSCLC. Moreover, although some studies suggest that it is associated with a worse prognosis in NSCLC (18), othersin concordance with or finding-report no association (19).…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of the pattern of pathological N1 lymph node metastases for non-small cell lung cancer

et al. 2019

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Background: In patients with non-small cell lung cancer (NSCLC) the pathologic lymph node status N1 is a heterogeneous entity, and different forms of lymph node involvement may represent different prognoses. For methodological reasons, the 8th edition of the TNM staging system for NSCLC makes no official changes to the N descriptor. However, there is evidence that different subforms of N1 disease are associated with different prognoses, and it is now recommended that clinicians record the number of affected lymph nodes and nodal stations for further analyses. In this investigation we sought to determine whether patients with different levels and types of N1 lymph node involvement had significantly different 5-year survival rates. Methods: We retrospectively identified 90 patients with NSCLC (61 men, 29 women), who were treated between 2008 and 2012 and found to have pathologic N1 lymph node involvement and tumor sizes corresponding to T1 or T2. All patients were treated in curative intent with surgical lung resection and systematic mediastinal and hilar lymph node dissection. Results: The overall 5-year survival rate was 56.3%. In the univariate analysis, lower tumor stage and tumor histology other than large-cell carcinoma were significantly associated with better long-term survival. Patients with solitary lymph node metastases also had longer disease-free survival than those with multiple nodal metastases. In the multivariate analysis, large-cell carcinoma and Union for International Cancer Control (UICC) stage IIB were independently associated with worse survival, while pneumonectomy, compared to lobar or sublobar resection, was independently associated with better survival. Conclusions: Although we did not observe significant prognostic differences between N1 subcategories within our patient population, other analyses may yield different results. Therefore, these data highlight the need for large, well-designed multicenter studies to confirm the clinical significance of N1 subcategories.

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Clinical prognostic markers in stage IIIC melanoma

Abstract: Although survival for patients with stage IIIC is poor in general, patients with both N3 disease and ECE constitute the group with the worst prognosis and should be considered for adjuvant therapy with ipilimumab or any other future effective adjuvant therapy (study).

Cited by 11 publications

References 22 publications

An evaluation of the role of locoregional treatments for the management of in-transit melanoma metastases

An evaluation of the role of locoregional treatments for the management of in-transit melanoma metastases

Neoadjuvant Systemic Therapy (NAST) in Patients with Melanoma: Surgical Considerations by the International Neoadjuvant Melanoma Consortium (INMC)

Prognostic significance of the pattern of pathological N1 lymph node metastases for non-small cell lung cancer

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