Advertisement

Annals of Surgical Oncology

, Volume 17, Issue 12, pp 3330–3335 | Cite as

The Prognostic Significance of Nonsentinel Lymph Node Metastasis in Melanoma

  • Russell E. Brown
  • Merrick I. Ross
  • Michael J. Edwards
  • R. Dirk Noyes
  • Douglas S. Reintgen
  • Lee J. Hagendoorn
  • Arnold J. Stromberg
  • Robert C. G. Martin
  • Kelly M. McMasters
  • Charles R. Scoggins
Melanomas

Abstract

Background

We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival.

Materials and methods

Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥1.0 mm in Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free survival (DFS) and overall survival (OS) were computed by Kaplan–Meier analysis; univariate and multivariate analyses were performed to identify factors associated with differences in survival among groups.

Results

A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6% for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4%, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence of ulceration, Clark level ≥ IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not.

Conclusions

NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive lymph nodes or the lymph node ratio.

Keywords

Overall Survival Sentinel Lymph Node Sentinel Lymph Node Biopsy Sentinel Lymph Node Metastasis Breslow Thickness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors would like to sincerely thank Deborah Hulsewede, Sherri Matthews, Wanda Greenwell, Pam Harlan, Alex Scroggins, and Ivan Deyahs for their dedication and hard work in managing the Sunbelt Melanoma Trial. We also express gratitude to Advertek, Inc., for their expert data management. Finally, we thank all of the patients, centers, and investigators who participated in the trial. This work is supported by a grant from Schering Oncology-Biotech. Schering Oncology-Biotech had no access to data, no input into the analysis of the data, and has not participated in the preparation or review of this manuscript.

References

  1. 1.
    Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.PubMedGoogle Scholar
  2. 2.
    Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83.PubMedGoogle Scholar
  3. 3.
    Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.CrossRefPubMedGoogle Scholar
  4. 4.
    Balch CM, Morton DL, Gershenwald JE, McMasters KM, Nieweg OE, Powell B, et al. Sentinel node biopsy and standard of care for melanoma. J Am Acad Dermatol. 2009;60:872–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Practice Guidelines in Oncology. Vol. 1. 2010: National Comprehensive Cancer Networks; 2009:ME-3.Google Scholar
  6. 6.
    Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.CrossRefPubMedGoogle Scholar
  7. 7.
    Gershenwald JE, Andtbacka RH, Prieto VG, Johnson MM, Diwan AH, Lee JE, et al. Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol. 2008;26:4296–303.CrossRefPubMedGoogle Scholar
  8. 8.
    McMasters KM, Wong SL, Edwards MJ, Chao C, Ross MI, Noyes RD, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol. 2002;9:137–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Reeves ME, Delgado R, Busam KJ, Brady MS, Coit DG. Prediction of nonsentinel lymph node status in melanoma. Ann Surg Oncol. 2003;10:27–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Sabel MS, Griffith K, Sondak VK, Lowe L, Schwartz JL, Cimmino VM, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg. 2005;201:37–47.CrossRefPubMedGoogle Scholar
  11. 11.
    Satzger I, Volker B, Meier A, Kapp A, Gutzmer R. Criteria in sentinel lymph nodes of melanoma patients that predict involvement of nonsentinel lymph nodes. Ann Surg Oncol. 2008;15:1723–32. CrossRefPubMedGoogle Scholar
  12. 12.
    Cadili A, Smylie M, Danyluk J, Dabbs K. Prediction of nonsentinel lymph node metastasis in malignant melanoma. J Surg Res. 2009;154:324–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Cascinelli N, Bombardieri E, Bufalino R, Camerini T, Carbone A, Clemente C, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24:4464–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Roka F, Mastan P, Binder M, Okamoto I, Mittlboeck M, Horvat R, et al. Prediction of non-sentinel node status and outcome in sentinel node-positive melanoma patients. Eur J Surg Oncol. 2008;34:82–8.PubMedGoogle Scholar
  15. 15.
    Ariyan C, Brady MS, Gonen M, Busam K, Coit D. Positive nonsentinel node status predicts mortality in patients with cutaneous melanoma. Ann Surg Oncol. 2009;16:186–90.CrossRefPubMedGoogle Scholar
  16. 16.
    Ghaferi AA, Wong SL, Johnson TM, Lowe L, Chang AE, Cimmino VM, et al. Prognostic significance of a positive nonsentinel lymph node in cutaneous melanoma. Ann Surg Oncol. 2009;16:2978–84.CrossRefPubMedGoogle Scholar
  17. 17.
    McMasters KM, Reintgen DS, Ross MI, Wong SL, Gershenwald JE, Krag DN, et al. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann Surg Oncol. 2001;8:192–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Scoggins CR, Martin RC, Ross MI, Edwards MJ, Reintgen DS, Urist MM, et al. Factors associated with false-negative sentinel lymph node biopsy in melanoma patients. Ann Surg Oncol. 2010;17:709–17.CrossRefPubMedGoogle Scholar
  19. 19.
    Scoggins CR, Ross MI, Reintgen DS, Noyes RD, Goydos JS, Beitsch PD, et al. Prospective multi-institutional study of reverse transcriptase polymerase chain reaction for molecular staging of melanoma. J Clin Oncol. 2006;24:2849–57.CrossRefPubMedGoogle Scholar
  20. 20.
    Morton DL. Sentinel node mapping and an International Sentinel Node Society: current issues and future directions. Ann Surg Oncol. 2004;11:137S–43S.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Russell E. Brown
    • 1
  • Merrick I. Ross
    • 2
  • Michael J. Edwards
    • 3
  • R. Dirk Noyes
    • 4
  • Douglas S. Reintgen
    • 5
  • Lee J. Hagendoorn
    • 6
  • Arnold J. Stromberg
    • 7
  • Robert C. G. Martin
    • 1
  • Kelly M. McMasters
    • 1
  • Charles R. Scoggins
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Louisville, James Graham Brown Cancer CenterLouisvilleUSA
  2. 2.Department of Surgical OncologyUniversity of Texas, MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of SurgeryUniversity of Cincinnati College of MedicineCincinnatiUSA
  4. 4.Department of SurgeryLDS HospitalSalt Lake CityUSA
  5. 5.Department of SurgeryLakeland Regional Cancer CenterLakelandUSA
  6. 6.Advertek, Inc.LouisvilleUSA
  7. 7.Department of StatisticsUniversity of KentuckyLexingtonUSA

Personalised recommendations