Microscopic Tumor Burden in Sentinel Lymph Nodes Predicts Synchronous Nonsentinel Lymph Node Involvement in Patients With Melanoma

Gershenwald, Jeffrey E.; Andtbacka, Robert H.I.; Prieto, Víctor G.; Johnson, Marcella M.; Diwan, Amna; Lee, Jeffrey E.; Mansfield, Paul F.; Cormier, Janice N.; Schacherer, Christopher W.; Ross, Merrick I.

doi:10.1200/jco.2007.15.4179

Cited by 198 publications

(143 citation statements)

References 54 publications

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“…Our aim was to identify variables easy to measure and reproducible to combine at the hope to identify clinically useful predictors of NSLN involvement and significant on OS. For that reason, we did not include in our analysis the SLN tumour burden, even if many studies have found the size of the metastatic deposits in the SLN to be predictive of NSLN involvement [7], [9], [10] and [11]. Also recently, Cadili et al [21] confirmed the prognostic relevance of SLN total tumour size on both NSLN involvement and disease course in a large melanoma patient cohort.…”

Section: Discussionmentioning

confidence: 84%

“…However, CLND carries significant morbidity [5] and [6] and there is no consensus on the benefit of a completion dissection in melanoma patients. In fact reports in the literature showed that only from 14 to 28% [7], [8], [9], [10] and [11] of positive patients will harbour further disease in the affected basin. Theoretically, only patients with involvement of additional, non-sentinel lymph nodes (NSLN) in the CLND specimen should benefit from a CLND.…”

Section: Introductionmentioning

confidence: 99%

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Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

Quaglino

Ribero²,

Osella‐Abate

et al. 2011

Surgical Oncology

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Dec 9. Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for nonsentinel lymph node involvement and overall survival in melanoma patients: a single centre observational cohort study. Quaglino P, Ribero S, Osella-Abate S, Macrì L, Grassi M, Caliendo V, Asioli S, Sapino A, Macripò G, Savoia P, Bernengo MG.You may download, copy and otherwise use the AAM for non-commercial purposes provided that your license is limited by the following restrictions:(1) You may use this AAM for non-commercial purposes only under the terms of the CC-BY-NC-ND license.(2) The integrity of the work and identification of the author, copyright owner, and publisher must be preserved in any copy. AbstractObjective: Completion Lymph Node Dissection (CLND) is the current standard of practice for patients with a positive Sentinel Lymph Node Biopsy (SLNB). Significant morbidity is associated to CLND, so we tried to evaluate which prognostic variables could predict NSLN invasion in SLN-positive patients and their impact on the overall survival (OS). Methods: A retrospective chart review of 603 patients that had undergone SLNB for melanoma between 2000 and 2009 at our department was done. 100 SLN were positive at the histopathological analysis of SLN. Demographic variables, primary melanoma, SLN pathologic features and results of CLND were analysed. Multivariate logistic regression and OS analyses were carried out to test the prognostic relevance of clinicopathologic variables on CLND results and disease course. Results: Breslow thickness, ulceration and micro/macrometastatic pattern of SLN invasion carried a significantly independent higher likelihood of NSLN involvement; Starz classification did not maintain a statistical significance in multivariate analysis. Only one patient (4.3%) without adverse prognostic factors showed NSLN involvement, which was found in 33.3% of patients with one and 55.9% with two or more adverse parameters (p = 0.0001). OS analyses confirmed the prognostic significance of these factors. Conclusion: Waiting for the results of Multicenter Selective Lymphadenectomy Trial II, our study suggests a clinically useful and easily applicable means of identifying patients with an unfavourable disease course. The presence of one or more adverse factors identifies patients in whom CLND is mandatory to include thereafter in a more strict follow-up program. Moreover, the finding of no adverse prognostic indicators associated to the presence of significant co-morbidities and/or elderly age, could be useful in identifying patients not to treat by CLND.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

Quaglino

Ribero²,

Osella‐Abate

et al. 2011

Surgical Oncology

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“…6,7 In short, SLNs were bread loafed, and the entire lymph node was processed; specimens in which the initial H&E-stained sections were negative were analyzed with additional sections and in an immunohistochemical study. We also reviewed re-excision and lymphadenectomy specimens.…”

Section: Treatment Approach and Follow-upmentioning

confidence: 99%

Prognostic factors for melanoma in children and adolescents

Paradela

Fonseca

Pita-Fernández

et al. 2010

Cancer

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BACKGROUND: Cutaneous melanoma in childhood is rare; therefore, its prognostic factors and biologic behavior and the effectiveness of adjuvant diagnostic techniques in this group remain mostly unknown. METHODS: The authors conducted a retrospective, observational study on the prognostic significance of clinical and pathologic findings from 137 cutaneous and mucosal melanomas in patients aged <18 years that were reviewed by the pathology department of a large cancer center during the period from 1992 to 2006. RESULTS: Univariate analysis indicated that there was a significantly greater risk of metastases for patients who had previous nonmelanocytic malignancies, nodular histologic type, fusiform or spitzoid cytology, high Breslow thickness, vertical growth phase, high dermal mitotic activity, ulceration, and vascular invasion. Adjacent nevus and radial growth phase were associated with a better prognosis. Twelve patients (10.3%) died during follow-up. Decreased overall survival was related significantly to age >10 years, previous nonmelanocytic malignancy, high Breslow thickness, high Clark level, and the presence of metastases at diagnosis. All patients who died were aged !11 years, and 8 of those patients had metastases at diagnosis. In multivariate analysis, higher Breslow thickness predicted an increased risk of metastases, whereas age >10 years and the presence of metastases at diagnosis were associated with decreased survival. CONCLUSIONS: Similar to adults, the detection of metastases at diagnosis in children with melanoma was 1 of the main factors that influenced overall survival. Melanomas that were detected in children aged <11 years appeared to have a less aggressive behavior than those detected in adults. Cancer 2010;116:4334-44.

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“…Similarly, in melanoma, increasing evidence is emerging to support the view that SLN metastasis size is of prognostic significance. [15][16][17][18][19][20] We have shown that stereology-based volume estimates of melanoma metastases in SLNs more accurately predict disease-free survival than measuring the maximum metastasis diameter. 21 Volume estimates based on the Cavalieri principle 22 require complete serial step-sectioning of the SLNs, a procedure not included in most SLN histologic protocols.…”

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confidence: 99%

Stage migration after minor changes in histologic estimation of tumor burden in sentinel lymph nodes

Riber-Hansen¹,

Nyengaard²,

Hamilton-Dutoit³

et al. 2009

Cancer

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Extraneural metastases of ependymoma are rare, and have been reported in the lungs, lymph nodes, pleura, mediastinum, liver, diaphragmatic muscle, and bone. We report a case of anaplastic ependymoma with distant metastases to the vertebral bones, lungs, liver, and lymph nodes following treatment with bevacizumab. Recent research has hypothesized that angiogenic tumors may develop means of resistance to antiangiogenic therapies, and some evidence suggests potential for antiangiogenic therapies to promote additional means for cancer spread. Nevertheless, antiangiogenic therapies continue to demonstrate potential as potent therapies for the treatment of many cancers, and should continue to be researched for future uses. Pediatr Blood Cancer 2013; 60: 143–145. © 2012 Wiley Periodicals, Inc.

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Microscopic Tumor Burden in Sentinel Lymph Nodes Predicts Synchronous Nonsentinel Lymph Node Involvement in Patients With Melanoma

Abstract: In melanoma patients with positive SLNs, SLN tumor burden, primary tumor thickness, and number of SLNs harvested may be useful in identifying a group at low risk for positive non-SLNs and be spared the potential morbidity of a cTLND.

Cited by 198 publications

References 54 publications

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

Prognostic factors for melanoma in children and adolescents

Stage migration after minor changes in histologic estimation of tumor burden in sentinel lymph nodes

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