Predictors and Survival Impact of False-Negative Sentinel Nodes in Melanoma
- 358 Downloads
The status of the sentinel lymph node in melanoma is an important prognostic factor. The clinical predictors and implications of false-negative (FN) biopsy remain debatable.
We compared patients with positive sentinel lymph node biopsy (SNB) [true positive (TP)] and negative SNB with and without regional recurrence [FN, true negative (TN)] from our prospective institutional database.
Among 2986 patients (84 FN, 494 TP, and 2408 TN; median follow-up 93 months), the incidence of FN-SNB was 2.8 %. While calculated FN rate was 14.5 % [84 FN/(494 TP + 84 FN) × 100], when we accounted for local/in-transit recurrence (LITR) this rate was 8.5 % [46 FN/(494 TP + 46 FN) × 100 %]. On multivariate analysis, male gender (OR 2.0, 95 % CI 1.1–3.6, p = 0.018), head/neck primaries (OR 2.5, 95 % CI 1.3–4.8, p < 0.006), and LITR (OR 3.5, 95 % CI 2.1–5.8, p < 0.001) were associated with FN-SNB. Melanoma-specific survival (MSS) for the FN group was similar to the TP group at 5 years (68 vs. 73 %, p = 0.539). However, MSS declined more for the FN group with a longer follow up and was significantly worse at 10 years (44 vs. 64 %, p < 0.001). On multivariate analysis, FN-SNB was a significant predictor of worse MSS in melanomas <4 mm in Breslow thickness (HR 1.6; 95 % CI 1.1–2.5, p = 0.021).
Male gender, LITR, and head and neck tumors were associated with FN-SNB. FN-SNB was an independent predictor of worse MSS in melanomas <4 mm in thickness, but this survival difference did not become apparent until after 5 years of follow-up.
KeywordsMelanoma Sentinel Lymph Node Sentinel Lymph Node Biopsy True Positive Regional Recurrence
This study was supported by the Dr. Miriam & Sheldon G Adelson Medical Research Foundation (Boston, MA), the Borstein Family Foundation (Los Angeles, CA), the John Wayne Cancer Institute Auxiliary (Santa Monica, CA), Mr. George W. Ogden, and Mr. John E. Connor. The authors are grateful to Gwen Berry for editorial assistance. This project was supported by grants R01 CA189163 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute or the National Institutes of Health.
Dr. M. B. Faries has served as a consultant for Amgen Inc, Astellas Pharma Inc, and Genentech Inc. All other authors have no financial disclosure. Dr. D.Y. Lee is the Harold McAlister Charitable Foundation Fellow.
- 16.Morton DL CL, Wong J. Intraoperative lymphatic mapping and selective lymphadenectomy: technical details of a new procedure for clinical stage I melanoma. In Paper presented at: 42nd Annual Meeting of the Society of Surgical Oncology, May 20–22, 1990, Washington, DC.Google Scholar
- 17.Essner R FL, Morton DL. A useful adjunct to intraoperative lymphatic mapping and selective lymphadenectomy in patients with clinical stage I melanoma. In Paper presented at: Annual Meeting of the Society of Surgical Oncology, March 17–20, 1994, Houston.Google Scholar
- 19.Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg. 1999;230(4):453–63; discussion 463–5.PubMedCentralCrossRefPubMedGoogle Scholar
- 25.Joosse A, Collette S, Suciu S, et al. Sex is an independent prognostic indicator for survival and relapse/progression-free survival in metastasized stage III to IV melanoma: a pooled analysis of five European organisation for research and treatment of cancer randomized controlled trials. J Clin Oncol. 2013;31(18):2337–46.CrossRefPubMedGoogle Scholar