Nonsentinel lymph node status identified as prognostic factor for melanoma-specific survival
Source: Healio/Hematology-Oncology, March 2014
Nonsentinel lymph node status appears to be an independent predictor of melanoma-specific survival and should be incorporated into the staging system for melanoma, results of a retrospective study suggest.
Researchers reviewed data from 1,538 melanoma patients with lymph node metastases confirmed through sentinel lymph node biopsy. Eligible patients underwent completion lymph node dissection at nine centers in Italy.
Median follow-up time was 45 months, and the following variables were evaluated for each patient: enrolling center, year of diagnosis, patient age and sex, primary tumor thickness, ulceration, Clark level of invasion, the number of excised and positive sentinel nodes at sentinel lymph node biopsy, and number of surgically removed and positive lymph nodes at dissection.
The researchers calculated melanoma-specific survival from the time of melanoma diagnosis to the time of melanoma mortality or last follow-up. They used multivariable Cox regression survival analysis to determine independent prognostic factors.
The researchers identified NSLN metastasis in 353 patients (23%). NSLN status was found to be an independent predictor of melanoma-specific survival (HR=1.34; 95% CI, 1.18-1.52).
Moreover, NSLN status was successful in identifying the prognoses of patients with two to three positive lymph nodes (n=387; HR=1.39; 95% CI, 1.07-1.81) independent of other staging factors.
A search of the literature revealed that this subgroup of patients was evaluated in two other studies, and pooled results (n=620 patients; 284 NSLN-negative, 336 NSLN-positive) determined that NSLN is a highly effective predictor (HR=1.59; 95% CI, 1.27-1.98) in melanoma patients with two to three positive lymph nodes.
“These findings not only have a prognostic relevance, but also could have some implications for characterizing the biology of melanoma progression from the primary tumor through the regional lymph nodes,” the researchers wrote