Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Abstract

Aim: To confirm the accuracy of sentine! node biopsy (SNB) procedure and its morbidity, and to investigate predictive factors for SN status and prognostic factors for disease-free survival (DFS) and disease-specific survival (DSS). Materials and methods: Between October 1997 and December 2004, 327 consecutive patients in one centre with clinically node-negative primary skin melanoma underwent an SNB by the triple technique, i.e. lymphoscintigraphy, blue-dye and gamma-probe. Multivariate logistic regression analyses as well as the Kaplan-Meier were performed. Results: Twenty-three percent of the patients had at least one metastatic SN, which was significantly associated with Breslow thickness (p < 0.001). The success rate of SNB was 99.1 % and its morbidity was 7.6%. With a median follow-up of 33 months, the 5-year DFS/ DSS were 43%/49% for patients with positive SN and 83.5%/87.4% for patients with negative SN, respectively. The false-negative rate of SNB was 8.6% and sensitivity 91.4%. On multivariate analysis, DFS was significantly worsened by Breslow thickness (RR = 5.6, p < 0.001), positive SN (RR = 5.0, p < 0.001) and male sex (RR = 2.9, p = 0.001). The presence of a metastatic SN (RR = 8.4, p < 0.001), male sex (RR = 6.1,p < 0.001), Breslow thickness (RR = 3.2,p = 0.013) and ulceration (RR = 2.6,p = 0.015) were significantly associated with a poorer DSS. Conclusion: SNB is a reliable procedure with high sensitivity (91.4%) and low morbidity. Breslow thickness was the only statistically significant parameter predictive of SN status. DFS was worsened in decreasing order by Breslow thickness, metastatic SN and male gender. Similarly DSS was significantly worsened by a metastatic SN, male gender, Breslow thickness and ulceration. These data reinforce the SN status as a powerful staging procedure. © 2007 Elsevier Ltd. All rights reserved.Keywords: Melanoma; Sentine! lymph node; Prognostic factors; Survival Introduction Sentinel node biopsy (SNB) is an important staging procedure and may be a potential therapeutic approach in the management of melanoma. Metastatic spreading from a primary melanoma can be explained by two possible theories. 1 In the "marker" hypothesis, the primary melanoma metastasizes * Corresponding author. Tel.: +41 21 314 23 54; fax: +41 2131428 51. E-mail address: maurice.matter@chuv.ch (M. Matter).0748-7983/$ -see front malter © 2007 Elsevier Ltd. Ali rights reserved. doi: 10.1016Ali rights reserved. doi: 10. /j.ejso.2007 simultaneously via lymphatic and haematogenous routes, so that the presence of regional lymph nodes metastases becomes a marker of the likelihood of systemic disease. In the "incubator" hypothesis, the primary melanoma targets regional lymph nodes where metastatic cells may survive and slowly grow but remain latent before spreading to distant sites. According to this second theory, it was suggested that early removal of involved regional lymph nodes in earlyand intermediate-stage melanoma could prevent the progression of the metastases and thus improve survival...

Factors Predictive of the Status of Sentinel Lymph Nodes in Melanoma Patients from a Large Multicenter Database

“…Factors that have been investigated include patient age, 1–24 sex, 1–21,23,24 site of primary tumor, 1–3,6,8–11,13–21,23–27 Breslow thickness, 1–27 Clark level, 1–4,6,8,9,12,13,15–18,20,23,24,27 ulceration, 1–8,10–20,22–24,26,27 vertical growth phase, 1,8,14,17 tumor-infiltrating lymphocytes (TIL), 1,6,10,15,17 tumor mitotic rate (TMR), 1,6,7,10,11,14–17,20,25 histologic type, 1,4,7,8,11,17,19,20,22 lymphovascular invasion (LVI), 1,7,8,10,11,14,22,23 regression, 1,6–8,10,11,14,22,24,28–30 number of draining basins, 1,4,7,8,11,12,16,17,22 number of SLNs collected, 7,11,17 T classification, …”

Quantitative histopathology identifies patients with thin melanomas who are at risk for metastases

“…Wide local excision and lymph node dissection are associated with complication rates of up to 25% [16][17][18]. Even sentinel lymph node biopsy is associated with a short-term complication rate of at least 5% [19].…”

Linfonodo sentinela em melanoma: experiência inicial de um centro do nordeste brasileiro

“…As confirmed in the case of other solid tumors, dissemination occurs principally through the lymphatic system following an orderly progression. 1 The sentinel lymph node (SLN), the first lymph node in the chain to receive drainage, permits a prediction to be made of the state of the entire chain of lymph nodes. Lymphatic mapping prior to surgery and selective lymphadenectomy of marked lymph nodes was first described by Morton in 1992 and is currently standard practice in the case of melanomas with Breslow depth > 1 mm or, irrespective of depth, for those with other characteristics such as Clark level > III or ulceration.…”

“…Lymphatic mapping prior to surgery and selective lymphadenectomy of marked lymph nodes was first described by Morton in 1992 and is currently standard practice in the case of melanomas with Breslow depth > 1 mm or, irrespective of depth, for those with other characteristics such as Clark level > III or ulceration. [1][2][3][4] Biopsy of the SLN represents a significant advantage since the procedure is less invasive. Only 20% of individuals with a Breslow depth of 1-4 mm develop metastases.…”

“…All these factors are associated with poorer prognosis. 1,8 The number of SLN identified at preoperative lymphoscintigraphy ranged from 1 to 5, with a mean of 1.89 per patient. In four individuals (44%), only one SLN was found, while in another four patients (44%), two SLN were found, and in one patient (11%), more than two SLN were found.…”