Total Sentinel Lymph Node Tumor Size Predicts Nonsentinel Node Metastasis and Survival in Patients with Melanoma

Cadili, Ali; Scolyer, Richard A.; Brown, Philip T.; Dabbs, Kelly; Thompson, John F.

doi:10.1245/s10434-010-1145-6

Cited by 27 publications

(16 citation statements)

References 18 publications

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“…A predictive model for NSN positivity for patients with positive SLN by Gershenwald et al identified SLN tumor burden, primary tumor thickness >2 mm, and number of SLNs harvested as independent predictors of NSN positivity on multivariable analysis. Separate studies found age ≥55 years, total SLN metastatic burden diameter ≥5 mm, and total SLN tumor deposit size, respectively, to be independent predictors of NSN positivity …”

Section: Discussionmentioning

confidence: 99%

A model for predicting low probability of nonsentinel lymph node positivity in melanoma patients with a single positive sentinel lymph node

Bhutiani

Egger

Stromberg

et al. 2018

Journal of Surgical Oncology

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Background Identifying factors associated with nonsentinel lymph node (NSN) metastases in melanoma patients with a single positive sentinel lymph node (SLN) could aid decision making regarding adjuvant therapy. We describe a model for identifying patients with a single positive SLN at low risk for NSN metastasis. Methods Factors associated with NSN metastasis in patients with a primary cutaneous melanoma and a single positive SLN who underwent completion lymph node dissection (CLND) were identified. These factors were used to construct a model for predicting the NSN status. The model was validated using a separate data set from another tertiary referral cancer center. Results In the training data set, 111 patients had a single positive SLN. Of these, 27 had positive NSN. SLN tumor deposit diameter ≥0.75 mm (OR, 3.43; P = 0.047), age ≥40 (OR, 12.14; P = 0.024), and multifocal SLN tumor deposit location (OR, 4.16; P = 0.0096) were independently associated with NSN positivity. Patients with 0 to 1 of these risk factors had a low risk of NSN metastasis in both the training (7.5%) and validation (4.6%) data sets. Conclusions A combination of patient and SLN tumor burden characteristics can help to identify patients with a single positive SLN who are at a low risk of NSN metastasis.

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Section: Discussionmentioning

confidence: 99%

A model for predicting low probability of nonsentinel lymph node positivity in melanoma patients with a single positive sentinel lymph node

Bhutiani

Egger

Stromberg

et al. 2018

Journal of Surgical Oncology

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“…Cadili et al reported that the total size of metastatic OS overall survival, DFS disease-free survival * Indicates statistically significant deposits in the sentinel lymph node of melanoma patients was significantly correlated with disease-specific survival and OS. 29 In the present study, we also presented the clinical relevance of the total size of pulmonary metastases with respect to patient survival; this was found to be an independent predictor for OS as well as number of metastatic nodules, using multivariate analysis. These results indicate that we should consider the number and total size of pulmonary metastases as independent predictors.…”

Section: Discussionmentioning

confidence: 78%

Oligo-Recurrence of Osteosarcoma Patients: Treatment Strategies for Pulmonary Metastases

et al. 2015

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“…Metastasis size is emerging as a strong prognostic factor for SLN-positive patients (2)(3)(4)(5)(6)(7)(8). However, there is continued discussion with regard to both the optimal method for metastasis size assessment and the implications of using reduced histological protocols that examine only the central parts of the SLNs (2,(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies of melanoma sentinel lymph node (SLN) metastasis location (1,2) and size (3)(4)(5)(6)(7)(8) have been conducted in recent years in an effort to optimize patient staging and treatment. Historically, most lymph nodes suspected of harbouring melanoma metastases were examined histologically by studying only a single haematoxylin-eosin (H&E)stained central section.…”

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confidence: 99%

Nodal distribution, stage migration due to diameter measurement and the prognostic significance of metastasis volume in melanoma sentinel lymph nodes: a validation study

Riber-Hansen

Hamilton-Dutoit

Steiniche

2014

APMIS

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To validate metastasis location, maximum metastasis diameter (MMD) measurement induced stage migration and the prognostic significance of total metastatic volume (TMV) in melanoma sentinel lymph nodes (SLNs). A new 227 patient SLN cohort examined by complete step sectioning (250 μm) was tested for TMV and MMD prognostic significance; metastasis location by three different three-level protocols (Central vs Peripheral vs Global); and potential treatment changing down-staging by two restricted five-level protocols [Reduced Central (250 μm) vs Reduced Even (500 μm) sections]. Both TMV and MMD independently predicted recurrence (TMV, hazard ratio (HR): 1.21; 95% confidence interval (CI) 1.07-1.37; p = 0.003; and MMD, HR: 1.46; 95% CI 1.08-1.98, p = 0.02) and melanoma-specific death (TMV, HR: 1.30; 95% CI 1.11-1.51; p = 0.001; and MMD, HR: 1.82; 95% CI 1.25-2.66, p = 0.002). The Central, Peripheral and Global protocols detected 72%, 76% and 83% of metastases found by complete step sectioning. Based on MMD, using the Reduced Central or Reduced Even protocols, potential treatment changing down-staging occurred in 20 (20%) or 13 (13%) of SLN-positive patients. This validation study establishes that: (i) metastases are globally located in melanoma SLNs; (ii) MMD but not TMV leads to uni-directional stage migration; and (iii) TMV analysis is of prognostic significance.

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Total Sentinel Lymph Node Tumor Size Predicts Nonsentinel Node Metastasis and Survival in Patients with Melanoma

Abstract: Total SN tumor size predicts the likelihood of non-SLN metastasis, and also predicts survival outcome.

Cited by 27 publications

References 18 publications

A model for predicting low probability of nonsentinel lymph node positivity in melanoma patients with a single positive sentinel lymph node

A model for predicting low probability of nonsentinel lymph node positivity in melanoma patients with a single positive sentinel lymph node

Oligo-Recurrence of Osteosarcoma Patients: Treatment Strategies for Pulmonary Metastases

Nodal distribution, stage migration due to diameter measurement and the prognostic significance of metastasis volume in melanoma sentinel lymph nodes: a validation study

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