Clinicopathologic models predicting non‐sentinel lymph node metastasis in cutaneous melanoma patients: Are they useful for patients with a single positive sentinel node?

Abstract

Background and Objectives Of clinically node‐negative (cN0) cutaneous melanoma patients with sentinel lymph node (SLN) metastasis, between 10% and 30% harbor additional metastases in non‐sentinel lymph nodes (NSLNs). Approximately 80% of SLN‐positive patients have a single positive SLN. Methods To assess whether state‐of‐the‐art clinicopathologic models predicting NSLN metastasis had adequate performance, we studied a single‐institution cohort of 143 patients with cN0 SLN‐positive primary melanoma who underwent subsequent completion lymph node dissection. We used sensitivity (SE) and positive predictive value (PPV) to characterize the ability of the models to identify patients at high risk for NSLN disease. Results Across Stage III patients, all clinicopathologic models tested had comparable performances. The best performing model identified 52% of NSLN‐positive patients (SE = 52%, PPV = 37%). However, for the single SLN‐positive subgroup (78% of cohort), none of the models identified high‐risk patients (SE > 20%, PPV > 20%) irrespective of the chosen probability threshold used to define the binary risk labels. Thus, we designed a new model to identify high‐risk patients with a single positive SLN, which achieved a sensitivity of 49% (PPV = 26%). Conclusion For the largest SLN‐positive subgroup, those with a single positive SLN, current model performance is inadequate. New approaches are needed to better estimate nodal disease burden of these patients.

Survival Impact of Immediate Complete Lymph Node Dissection for Chinese Acral and Cutaneous Melanoma with Micrometastasis in Sentinel Nodes: A Retrospective Study

“…It suggests that to predict NSN status might still be important in future practice. There have been several studies published to evaluate prognostic factors or establish clinicopathologic models to predict positive NSN [15][16]. In our previous study based on 328 SN positive melanoma in Chinese population, the Breslow thickness, Clark level and number of positive SNs were independently related to positive NSN.…”

Survival impact of immediate complete lymph node dissection for Chinese acral and cutaneous melanoma with micrometastasis in sentinel nodes: a retrospective study

“…It suggests that predicting NSN status might still be important in the future practice. Several studies have been published to evaluate prognostic factors or establish clinicopathologic models to predict positive NSN [ 15 , 16 ]. In our previous study based on 328 SN-positive melanoma in the Chinese population, Breslow thickness, Clark level, and the number of positive SNs were independently related to positive NSN.…”

Modern Approach to Melanoma Adjuvant Treatment with Anti-PD1 Immune Check Point Inhibitors or BRAF/MEK Targeted Therapy: Multicenter Real-World Report

“…Most of them elaborate extensively on clinicopathological features. A recent study performed by a Dutch-American group has shown that currently available predictive models are not efficient and not validated for single positive SLNB, and they show limited performance in this subgroup of patients [25]. Their study analyzed the specific patient group with a single positive SLN, and they did not find any model that would identify patients at high risk of NSLN in a group of single positive SLN.…”

“…For the purpose of analysis, all patients were clustered into three groups according to the type of surgery before adjuvant treatment: surgery without recurrence (primary melanoma and nodes: positive sentinel lymph node biopsy (SLNB) +/− completion lymph node dissection (CLND)), surgery after local recurrence (therapeutic lymph node dissection (TLND) +/− in-transit resection), and surgery after distant recurrence (resected M1) (Table 2). Within the primary surgery group (resection of primary melanoma and/or nodes), there were patients who underwent TLND without SLNB (33,25.4%), those who underwent CLND after positive SLNB (63, 48.5%), and those who had positive SLNB but no CLND afterwards (34,26.2%). There were 174 (70%) patients with intervals longer than 13 weeks from the last operation to adjuvant treatment start.…”

“…The problem of survival lies within a spectrum of distant metastases, and translational research implementing information from clinical, histopathological, serological, and molecular biomarkers would be of predictive and prognostic value [27,28]. Researchers from the Dutch-American group assume that exploitation of the clinicopathological features of SLN has reached its peak [25]. Scientists are looking closely at early-stage melanoma given that the biggest rate of deaths is attributed to thin melanomas (23%), while thick or metastatic-at-presentation melanomas are responsible for 14% and 16% of deaths, respectively [29].…”