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The sentinel lymph node spread determines quantitatively melanoma seeding to non-sentinel lymph nodes and survival.
- Source :
-
European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2018 Mar; Vol. 91, pp. 1-10. Date of Electronic Publication: 2018 Jan 06. - Publication Year :
- 2018
-
Abstract
- Introduction: Complete lymph node dissection (CLND) after a positive sentinel node (SN) biopsy provides important prognostic information in melanoma patients but has been questioned for therapeutic use recently. We explored whether quantification of the tumour spread to SNs may replace histopathology of non-sentinel nodes (NSNs) for staging purposes.<br />Patients and Methods: We quantified melanoma spread in SNs and NSNs in 128 patients undergoing CLND for a positive SN. In addition to routine histopathology, one-half of each of all 1496 SNs and NSNs was disaggregated into a single cell suspension and stained immunocytochemically to determine the number of melanoma cells per 10 <superscript>6</superscript> lymph node cells, i.e. the disseminated cancer cell density (DCCD).<br />Results: We uncovered melanoma spread to NSNs in the majority of patients; however, the tumour load and the proportion of positive nodes were significantly lower in NSNs than in SNs. The relation between SN and NSN spread could be described by a mathematical function with DCCD <subscript>NSN</subscript>  = DCCD <subscript>SN</subscript> <superscript>c</superscript> /10 <superscript>1</superscript> <superscript>-</superscript> <superscript>c</superscript> (c = 0.69; 95% confidence interval [CI]: 0.62-0.76). At a median follow-up of 67 months, multivariable Cox regression analyses revealed that DCCD <subscript>SN</subscript> (p = 0.02; HR 1.34, 95% CI: 1.05-1.71) and the total number of pathologically positive nodes (p = 0.02; HR 1.53, 95% CI: 1.07-2.22) were significant risk factors after controlling for age, gender, thickness of melanoma and ulceration status. A prognostic model based on DCCD <subscript>SN</subscript> and melanoma thickness predicted outcome as accurately as a model including pathological information of both SNs and NSNs.<br />Conclusion: The assessment of DCCD <subscript>SN</subscript> renders CLND for staging purposes unnecessary.<br /> (Copyright © 2017 Elsevier Ltd. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Female
Humans
Kaplan-Meier Estimate
Lymph Node Excision
Lymph Nodes surgery
Lymphatic Metastasis
Male
Melanoma mortality
Melanoma surgery
Middle Aged
Multivariate Analysis
Neoplasm Staging
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Skin Neoplasms mortality
Skin Neoplasms surgery
Young Adult
Lymph Nodes pathology
Melanoma secondary
Sentinel Lymph Node Biopsy
Skin Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0852
- Volume :
- 91
- Database :
- MEDLINE
- Journal :
- European journal of cancer (Oxford, England : 1990)
- Publication Type :
- Academic Journal
- Accession number :
- 29316475
- Full Text :
- https://doi.org/10.1016/j.ejca.2017.12.002