TY - JOUR
T1 - Sentinel lymph node tumor load
T2 - An independent predictor of additional lymph node involvement and survival in melanoma
AU - Vuylsteke, Ronald J.C.L.M.
AU - Borgstein, Paul J.
AU - Van Leeuwen, Paul A.M.
AU - Gietema, Hester A.
AU - Molenkamp, Barbara G.
AU - Muller, Markwin G.Statius
AU - Van Diest, Paul J.
AU - Van Der Sijp, Joost R.M.
AU - Meijer, Sybren
N1 - Funding Information:
Supported by a grant from the Fritz Ahlqvist Foundation.
PY - 2005/6
Y1 - 2005/6
N2 - Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load. Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had 1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs. The mean SLN metastatic area was 1.18 mm2 (group 1) and 3.39 mm2 (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm2 had a positive ALN. SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm2 seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.
AB - Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load. Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had 1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs. The mean SLN metastatic area was 1.18 mm2 (group 1) and 3.39 mm2 (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm2 had a positive ALN. SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm2 seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.
KW - Additional lymph node
KW - Melanoma
KW - Metastatic area
KW - Sentinel lymph node
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U2 - 10.1245/ASO.2005.06.013
DO - 10.1245/ASO.2005.06.013
M3 - Article
C2 - 15864481
AN - SCOPUS:21244478180
SN - 1068-9265
VL - 12
SP - 440
EP - 448
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 6
ER -