Implementation of the 7th edition AJCC staging system: effects on staging and survival for pT1 melanoma. A Dutch population based study

Ophuis, Charlotte Oude; Louwman, Marieke W. J.; Grünhagen, D.J.; Verhoef, C.; Akkooi, A. Van

doi:10.1016/s0959-8049(17)30495-1

Cited by 2 publications

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“…However, before the introduction of adjuvant therapy, only 40-63% of eligible patients in Europe underwent SLNB. [20][21][22][23][24] This could be attributed to the fact that, although less invasive than elective lymph node dissection, morbidity associated with SLNB is not negligible. 22,25 In addition, the SLNB positivity rate varies between 15% and 30%.…”

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confidence: 99%

“…The most recent estimates of the number of SLNB procedures performed in the adjuvant therapy era are not yet available. However, before the introduction of adjuvant therapy, only 40–63% of eligible patients in Europe underwent SLNB 20–24 . This could be attributed to the fact that, although less invasive than elective lymph node dissection, morbidity associated with SLNB is not negligible 22,25 .…”

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confidence: 99%

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Validation of a clinicopathological and gene expression profile model for sentinel lymph node metastasis in primary cutaneous melanoma*

Mulder

Dwarkasing²,

Tempel³

et al. 2020

Br J Dermatol

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Background The Clinicopathological and Gene Expression Profile (CP-GEP) model was developed to accurately identify patients with T1-T3 primary cutaneous melanoma at low risk for nodal metastasis. Objectives To validate the CP-GEP model in an independent Dutch cohort of patients with melanoma. Methods Patients (aged ≥ 18 years) with primary cutaneous melanoma who underwent sentinel lymph node biopsy (SLNB) between 2007 and 2017 at the Erasmus Medical Centre Cancer Institute were eligible. The CP-GEP model combines clinicopathological features (age and Breslow thickness) with the expression of eight target genes involved in melanoma metastasis (ITGB3, PLAT, SERPINE2, GDF15, TGFBR1, LOXL4, CXCL8 and MLANA). Using the pathology result of SLNB as the gold standard, performance measures of the CP-GEP model were calculated, resulting in CP-GEP high risk or low risk for nodal metastasis. Results In total, 210 patients were included in the study. Most patients presented with T2 (n = 94, 45%) or T3 (n = 70, 33%) melanoma. Of all patients, 27% (n = 56) had a positive SLNB, with nodal metastasis in 0%, 30%, 54% and 16% of patients with T1, T2, T3 and T4 melanoma, respectively. Overall, the CP-GEP model had a negative predictive value (NPV) of 90Á5% [95% confidence interval (CI) 77Á9-96.2], with an NPV of 100% (95% CI 72Á2-100) in T1, 89Á3% (95% CI 72Á8-96Á3) in T2 and 75Á0% (95% CI 30Á1-95Á4) in T3 melanomas. The CP-GEP indicated high risk in all T4 melanomas. Conclusions The CP-GEP model is a noninvasive and validated tool that accurately identified patients with primary cutaneous melanoma at low risk for nodal metastasis. In this validation cohort, the CP-GEP model has shown the potential to reduce SLNB procedures in patients with melanoma.What is already known about this topic?• The majority (70-85%) of patients with cutaneous melanoma who undergo a sentinel lymph node biopsy (SLNB) procedure have no metastasis in the SLN.• To identify patients at low risk for nodal metastasis, the Clinicopathological and Gene Expression Profile (CP-GEP) model was developed (n = 754 patients, US cohort).• The CP-GEP model combines age, Breslow thickness and the expression of eight target genes involved in melanoma metastasis, and has the potential to reduce SLNB procedures in patients with T1-T3 cutaneous melanoma.

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Validation of a clinicopathological and gene expression profile model for sentinel lymph node metastasis in primary cutaneous melanoma*

Mulder

Dwarkasing²,

Tempel³

et al. 2020

Br J Dermatol

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“…This was because the criteria of the 7 th Edition of the AJCC staging system would have caused an increase in the number of patients to be submitted to SLN biopsy, without a corresponding increase in the positive rate of SLN biopsy [5]. Therefore, reconsideration of the mitotic criterion for T1b classification and of recommendations to perform SLN biopsy for pT1b melanoma has been advanced [6].…”

Section: Ajcc 7 Th Editionmentioning

confidence: 99%

AJCC 8th Edition (2017) versus AJCC 7th Edition (2010) in thin melanoma staging

Roncati

Piscioli

2018

neo

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In comparison with the 7th Edition, the 8th Edition of the American Joint Committee on Cancer (AJCC) staging system no longer considers the mitotic count in the a or b T1 categorization for melanoma, but it adopts a sub-stratification based on the Breslow's depth. Today, the death burden of thin melanoma is still severe, despite of attempts for early screening. We believe that a bio-histological implementation may explain this evidence. It is generally accepted that melanoma progression includes two subsequent phases: the radial growth phases (RGP) and the vertical growth phase (VGP). If left untreated, RGP is able to move towards VGP. In this second phase, melanoma grows as a malignant, mitotically active, tumor with invasive and metastatic capacities. By our experience, thin melanoma includes three bio-histological subtypes: the non-tumorigenic micro-invasive RGP without significant regression, the micro-invasive RGP with regression of uncertain tumorigenic potential at diagnosis, due to the extensive presence (> 75%) of regression which could contain a VGP clone, and the micro-invasive tumorigenic VGP. Therefore, we are prone to support that the prognosis of thin melanoma is correlated with the type of growth phase inside it.

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Implementation of the 7th edition AJCC staging system: effects on staging and survival for pT1 melanoma. A Dutch population based study

Cited by 2 publications

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Validation of a clinicopathological and gene expression profile model for sentinel lymph node metastasis in primary cutaneous melanoma*

Validation of a clinicopathological and gene expression profile model for sentinel lymph node metastasis in primary cutaneous melanoma*

AJCC 8th Edition (2017) versus AJCC 7th Edition (2010) in thin melanoma staging

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