Soft tissue sarcoma: the predominant primary malignancy in the retroperitoneum

Purpose. In the clinical work-up of a retroperitoneal mass, the diagnosis of soft tissue sarcoma is often not considered. Incidence rates of various malignant and benign retroperitoneal tumours were studied to determine the incidence of soft tissue sarcoma in comparison with other neoplasms in the retroperitoneal space.

Method. Nation-wide data on retroperitoneal tumours, collected prospectively over a 5-year period (1 January 1989– 1 January 1994), were supplied by the Netherlands Cancer Registry and The Dutch Network and National Database for Pathology.

Results. Seven hundred and six patients with a primary retroperitoneal neoplasm were identified; 566 patients had a malignant tumour (80%). A soft tissue sarcoma (STS) was the most frequently diagnosed malignant tumour (n = 192), The agestandardised incidence of retroperitoneal STS was 2.5 per million person-years. The male/female ratio for STS was 0.73. In females, STS comprised 41%of all malignant retroperitoneal tumours, carcinoma of unknown primary tumour site (CUP) comprised 31%, and malignant lymphomas (ML) comprised 22%, whereas in males these values were 28% (STS), 30% (CUP), and 32% (ML), respectively.

Discussion. Soft tissue sarcomas, albeit rare, are relatively common primary tumours in the retroperitoneum, especially in women.

Survival of metal-on-metal hip resurfacing arthroplasty: a systematic review of the literature

We systematically reviewed the peer-reviewed literature to relate the survival of hybrid metal-on-metal hip resurfacing arthroplasty devices to a National Institute of Clinical Excellence (NICE) benchmark for choosing a primary total hip replacement, which is a survival rate of 90% at a follow-up of ten years. A total of 29 articles (10 621 resurfaced hips) met the inclusion criteria. The mean follow-up ranged from 0.6 to 10.5 years and the survival of the implant ranged from 84% to 100%. Of the 10 621 hips, 370 were revised (3.5%), with aseptic loosening as the most frequent mode of failure. None of the hip resurfacing arthroplasty implants used to date met the full ten-year NICE benchmark of survival. A total of 13 studies showed satisfactory survival compared with the three-year NICE benchmark.

Prevalence of paraneoplastic hyperthyroidism in patients with metastatic non-seminomatous germ-cell tumors

BACKGROUND

Patients with elevated human chorionic gonadotrophin (HCG) can have hyperthyroidism. We assessed the prevalence of hyperthyroidism in patients presenting with disseminated non-seminomatous germ-cell tumors (NSGCT).

PATIENTS AND METHODS

In all patients with metastatic NSGCT who started chemotherapy at our center from April 2001 to April 2007, thyroid function was analyzed. The association between thyroid function and HCG level was examined and the frequency of hyperthyroidism in patients with low (<5000 IU/l), intermediate (> or = 5000 but <50 000 IU/l) and high (> or = 50 000 IU/l) serum HCG was assessed.

RESULTS

For 144 of 148 eligible patients, thyroid function tests were available. Five patients with hyperthyroidism (3.5%) were identified, who all had high-serum HCG (mean 1 325 147 IU/l). Fifty percent of the patients with high HCG levels had hyperthyroidism versus 0% of the patients with HCG <50 000 IU/l (P < 0.001). Free thyroxin levels normalized within 26 days after starting chemotherapy in all patients.

CONCLUSIONS

Hyperthyroidism frequently accompanies NSGCT with highly elevated HCG. Since its symptoms overlap with those of extensive metastatic disease, it may not be recognized. Thyroid function should be assessed in patients with high HCG levels and symptomatic hyperthyroidism should be treated temporarily with beta-blockade or antithyroidal medication.

Follow-up schedules after treatment for malignant melanoma

BACKGROUND

Existing follow-up guidelines after treatment for melanoma are based largely on dated literature and historical precedent. This study aimed to calculate recurrence rates and establish prognostic factors for recurrence to help redesign a follow-up schedule.

METHODS

Data were retrieved from the Sydney Melanoma Unit database for all patients with a single primary melanoma and American Joint Committee on Cancer (AJCC) stage I-II disease, who had received their first treatment between 1959 and 2002. Recurrence rates, timing and survival were recorded by substage, and predictive factors were analysed.

RESULTS

Recurrence occurred in 18.9 per cent (895 of 4748) of patients overall, 5.2 per cent (95 of 1822) of those with stage IA disease, 18.4 per cent (264 of 1436) with IB, 28.7 per cent (215 of 750) with IIA, 40.6 per cent (213 of 524) with IIB and 44.3 per cent (86 of 194) with IIC disease. Overall, the median disease-free survival time was 2.6 years, but there were marked differences between AJCC subgroups. Primary tumour thickness, ulceration and tumour mitotic rate were important predictors of recurrence.

CONCLUSION

A new follow-up schedule was proposed: stage I annually, stage IIA 6-monthly for 2 years and then annually, stage IIB-IIC 4-monthly for 2 years, 6-monthly in the third year and annually thereafter.

The European approach to in-transit melanoma lesions

The biological behavior of melanoma is unpredictable. Three to five per cent of melanoma patients will develop in-transit lesions and the median time to recurrence ranges between 13-16 months. At the time of recurrence the risk of occult nodal metastasis, with clinically negative regional lymph nodes, is as high as 50%. The risk of in-transit lesions depends on the tumor biology and not on the surgical approach to the regional lymph nodes. The high incidence of in-transit lesions at the lower limb may be caused by the gravity and delayed lymphatic drainage. The treatment of limited disease is local excision, laser ablation, cryosurgery, while multiple in-transit lesions or bulky disease located in a limb can be successfully treated with regional chemotherapy, a therapeutic isolated limb perfusion or infusion with melphalan or a combination of melphalan and tumor necrosis factor (TNF) alpha. If local regional treatment or systemic dacarbazine based systemic treatment fails, novel systemic treatment strategies with vaccines, antibodies and gene therapy are currently investigated.

[Detection of the first recurrence in patients with melanoma: three quarters by the patient, one quarter during outpatient follow-up]

OBJECTIVE

To evaluate the benefit of frequent outpatient follow-up after the initial diagnosis and treatment of melanoma.

DESIGN

Retrospective study.

METHOD

Patients from the Groningen University Medical Centre with a first recurrence ofa previously treated primary melanoma (American Joint Committee on Cancer stage I-III) were interviewed to determine how many of them had detected the recurrence themselves. Patient data and recurrence characteristics were compared with data from a previous Australian study in order to evaluate the differences between the Dutch and the Australian population.

RESULTS

70 patients with a first recurrence of melanoma were studied. Of the 70 first recurrences, 53 (76%) had been detected by the patient; 10% of the patients had a sign or symptom, but did not detect the recurrence themselves; 11% of the first recurrences were detected as a consequence of self-examination. The proportion of detection by the patient versus detection by a doctor was roughly equal in the Dutch and Australian populations.

CONCLUSION

Three quarters of the first recurrences of a treated melanoma had been detected by the patients themselves, the largest number by accident and only 11% by self-examination. It is not likely that the continuation of frequent follow-up visits will contribute to the detection of recurrences. These findings are no different from the results in the Australian population.

Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study

BACKGROUND

A number of elderly cancer patients do not receive standard surgery for solid tumors because they are considered unfit for treatment as a consequence of inaccurate estimation of the operative risk. To tailor treatment to onco-geriatric series, oncologists are now beginning to use a comprehensive geriatric assessment (CGA). This study investigates the value of an extended CGA in assessing the suitability of elderly patients for surgical intervention.

PATIENTS AND METHODS

Preoperative assessment of cancer in the elderly (PACE) incorporates validated instruments including the CGA, an assessment of fatigue and performance status and an anaesthesiologist's evaluation of operative risk. An international prospective study was conducted using 460 consecutively recruited elderly cancer patients who received PACE prior to elective surgery. Mortality, post-operative complications (morbidity) and length of hospital stay were recorded up to 30 days after surgery.

RESULTS

Poor health in relation to disability (assessed using the instrumental activities of daily living (IADL)), fatigue and performance status (PS) were associated with a 50% increase in the relative risk of post-operative complications. Multivariate analysis identified moderate/severe fatigue, a dependent IADL and an abnormal PS as the most important independent predictors of post-surgical complications. Disability assessed by activities of daily living (ADL), IADL and PS were associated with an extended hospital stay.

CONCLUSION

PACE represents a valuable tool in enhancing the decision process concerning the candidacy of elderly cancer patients for surgical intervention and can reduce inappropriate age-related inequity in access to surgical intervention. It is recommended that PACE be used routinely in surgical practice.

[Myositis as the first manifestation of an exacerbation of Crohn's disease]

A 19-year-old man presented with general malaise and a swelling in the right hip region and right thigh. The CT images were interpreted as an abscess of the thigh, but surgical exploration revealed a diffuse myositis, with panniculitis, necrosis and inflammation of muscle tissue, associated with an exacerbation of Crohn's disease. The disease responded well to pharmacotherapy, but later an enterocutaneous fistula developed in the direction of the hip, caused by Crohn colitis in the pelvic area, for which resection of the small intestine was carried out followed by a primary anastomosis. The primary treatment of myositis associated with inflammatory bowel disease is medicinal. Being alert to this very uncommon association may prevent unnecessary surgical intervention.

Image guided surgery: New technology for surgery of soft tissue and bone sarcomas

AIM

Providing the surgical oncologist with a new means of performing safe and radical sarcoma surgery with the help of image guidance technology.

METHOD

Two patients with pelvic sarcomas were operated upon with the help of an intra-operative navigation system. The technology of image guided surgery is described in one patient with a retroperitoneal sarcoma invading the bony pelvis and another patient with a chondrosarcoma of the iliac crest.

RESULTS

We show that this new procedure enables optimal radical surgical resection with minimal treatment related morbidity or loss of function.

CONCLUSION

Image guided surgery is a new technical tool in sarcoma surgery.

Long-term prognosis of primary retroperitoneal soft tissue sarcoma

AIMS

To evaluate the result of treatment and long-term outcome of a population-based cohort of patients with retroperitoneal soft tissue sarcoma (RSTS).

METHODS

Between 1 January 1989 and 1 January 1994, 143 patients diagnosed as having primary RSTS were selected from a national pathology database (PALGA) in the Netherlands. In this population-based group of patients, the result of surgery, overall survival (OS) and disease-free survival (DFS) were analysed as well as factors affecting OS and DFS. Median follow-up was 10.2 years.

RESULTS

Operative treatment resulted in a complete tumour resection in 55% of the patients (n=78), low- and intermediate-grade tumours were more often completely resected than high-grade tumours (P=0.016). Five- and 10-year cumulative OS was 39% and 21%, respectively, while DFS was 22% and 17%, respectively. In a multivariate analysis low malignancy grade (P=0.017) and a complete tumour resection (P<0.001) were associated with better OS.

CONCLUSIONS

Complete tumour resection and low malignancy grade were independent favourable prognosticators. However, these factors were related too, since surgical success was influenced by malignancy grade.

Pre-operative assessment of cancer in the elderly (PACE): A comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery

BACKGROUND

Cancer is a disease that particularly affects the elderly and, although surgery is the first treatment choice, many elderly cancer patients do not receive standard surgery because they are considered unfit for treatment due to an inaccurate estimation of operative risk. Pre-operative Assessment of Cancer in the Elderly (PACE) was developed in order to address the need to provide detailed information about the functional reserve of the elderly cancer patient to aid individualised management.

METHODS

PACE incorporates a battery of validated instruments including the Comprehensive Geriatric Assessment (CGA), Brief Fatigue Inventory (BFI), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and American Society Anesthesiologists (ASA) grade. An international prospective study was conducted with 460 consecutive elderly cancer patients (216 breast, 146 GIT, 71 GUT, 27 other) receiving PACE prior to receiving elective surgery.

RESULTS

Three hundred and eighty four patients (83.4%) were observed to have at least one co-morbidity; the most common being hypertension (n=246, 53.5%). More than two thirds of the patients had good functional and mental status according to PACE. After adjusting for age, sex and type of cancer, six of the seven items of PACE were found to be significantly associated with co-morbidities (according to the Satariano's Index of Co-morbidities (SIC)). A multivariate analysis identified IADL, BFI and ASA to be the most important instruments in explaining SIC.

DISCUSSION

PACE has been effectively used to describe the functional capacity and health status in an international cohort of elderly cancer patients. The majority of PACE instruments have been found to be significantly associated with co-morbidities (SIC) and can distinguish between type and severity of cancer. PACE represents a useful tool in evaluating onco-geriatric fitness for surgery.

Morbidity after inguinal sentinel lymph node biopsy and completion lymph node dissection in patients with cutaneous melanoma

BACKGROUND

Aim of the study was to assess the short-term and long-term morbidity after inguinal sentinel lymph node biopsy (SLNB) with or without completion groin dissection (GD) in patients with cutaneous melanoma.

METHODS

Between 1995 and 2003, 127 inguinal SLNBs were performed for cutaneous melanoma. Sixty-six patients, median age 50 (18-77) years, met the inclusion criteria and were studied. Short-term complications were analysed retrospectively, while long-term complications were evaluated using volume measurement and range of motion measurement of the lower extremities.

RESULTS

Fifty-two patients underwent SLNB alone (SLNB group) and 14 patients underwent completion groin dissection after tumour-positive SLNB (SLNB/GD group). Morbidity after SLNB alone: wound infections (n=1), seroma (n=1), postoperative bleeding (n=1), erysipelas (n=1), and slight lymphedema 6% (n=3). Morbidity after SLNB/GD: wound infections (n=4), seroma (n=1), wound necrosis (n=1), postoperative bleeding (n=1), and slight lymphedema 64% (n=9). There were differences between the two groups in the total number of short-term complications (p<0.001), volume difference (p<0.001), flexion (p=0.009), and abduction (p=0.011) limitation of the hip joint.

CONCLUSION

Inguinal SLNB is accompanied with a low complication rate. However, SLNB followed by groin dissection is associated with an increased risk of wound infection and slight lymphedema.

The role of meaning in the prediction of psychosocial well-being of testicular cancer survivors

Stressful life events, such as cancer, may threaten the belief that life is meaningful and this may have a negative effect on well-being. This study aimed at: (1) examining meaning in testicular cancer survivors (TCSs); (2) changes in outlook on life after testicular cancer (TC); (3) the contribution of meaning in the prediction of psychosocial well-being and cancer-related distress. A total of 354 TCSs completed relevant questionnaires. Results showed that: (1) TCSs experience their lives as meaningful; (2) most TCSs (60%) report a more positive outlook on life since TC; (3) meaning is the most important predictor for psychosocial well-being, but its relationship with cancer-related distress is weak. These results indicate that the cancer experience did not (permanently) disrupt the sense of meaning in TCSs. Furthermore, results confirm the idea that a sense of meaning has a positive effect on psychosocial well-being. Meaning appeared to have little effect on cancer-related distress. However, previous research has shown that this relationship may be too complex to unravel with a cross-sectional design. Therefore, it is suggested to further investigate the underlying interacting mechanisms between meaning and cancer-related distress.

Re-analysis of the Xq27–Xq28 region suggests a weak association of an X-linked gene with sporadic testicular germ cell tumour without cryptorchidism

BACKGROUND

A testicular germ cell tumour (TGCT) predisposing gene has been mapped to the Xq27 region on the X chromosome. These linkage findings remain to be confirmed by other studies.

METHODS

In 276 patients and 169 unaffected first-degree male relatives, 12 microsatellite markers covering the candidate region were genotyped and used to study possible association of TGCT with Xq27.

RESULTS

In contrast to previously reported linkage of familial TGCT and cryptorchidism with Xq27, we observed an association between the subset of TGCT cases without a family history of TGCT or cryptorchism and marker DXS1193 (p=0.014). Carriers of minor alleles were at increased risk (odds ratio (OR) 4.7, confidence interval (CI) 1.1-19.6)

CONCLUSION

We found an association on Xq27 in a subset of TGCT cases, which suggests the presence of an X-linked gene that slightly or moderately increases risk to develop sporadic TGCT but not cryptorchidism.

Adolescent melanoma: Risk factors and long term survival

AIMS

To report the adolescent melanomas with focus on differences in clinical characteristics, prognostic factors, disease free (DFS) and overall survival (OS) in comparison with adults.

METHODS

A single institution retrospective study in which 49 adolescent patients were compared to an adult group of 972 patients. The 10-year DFS, 10-year OS and prognostic factors were calculated for both groups.

RESULTS

The median age for the adolescent patients was 17 (range 12-19) years and 49 (range 20-93) years for the adult patients. Median follow-up time was 92 (range 4-366) months. Adolescent patients presented more often with locally advanced melanoma (p<0.01). The median Breslow thickness was 1.6 vs 2.0mm for the adults (p=0.075). Increasing age, ulceration, Breslow thickness, tumour location, male gender and stage at diagnosis were calculated to be negative prognostic factors for the adult group. In the adolescent group, only the stage at diagnosis was a significant negative predictor. The 10-year DFS and OS for the adolescent patients and adult group were not significantly different regarding AJCC stages I-III.

CONCLUSION

Although adolescent patients presented more often with locally advanced disease, there are no significant differences in the 10-year DFS and OS between adolescent and adult patients. In our series, we could not confirm the prognostic factors found in the adult group for the adolescent patients, except for the stage at diagnosis.

Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer

BACKGROUND

In a prospective study, long term upper-limb morbidity, perceived disabilities in activities of daily life (ADL) and quality of life (QOL) were assessed before and 2 years after sentinel lymph node biopsy (SLNB) or axillary lymph node dissections (ALND) for breast cancer.

METHODS

Two hundred and four patients with stage I/II breast cancer, mean age 55.6 years (SD: 11.6) entered the study and 181 patients (89%) could be evaluated after 2 years. Fifty-seven patients underwent SLNB (31%) and 124 patients underwent an ALND (69%). Assessments included pain, shoulder range of motion, muscle strength, arm volume, perceived shoulder disability in ADL and QOL.

RESULTS

Significant (P<0.05) changes between before and 2 years after surgery were found in almost all assessments of shoulder function, ADL and several QOL subscales. Patients in the ALND group showed significant more changes in range of motion (ROM), grip strength, arm volume, ADL and QOL physical- and role functioning, pain and sleeplessness and arm symptoms compared to the SLNB group. Multivariate linear regression analysis showed that ALND could predict decrease of ROM, grip strength, ADL and physical functioning (QOL) and increase of arm volume, pain and arm symptoms score (QOL). Radiation on the axilla predicts an additional decrease in shoulder ROM and increase of arm volume.

CONCLUSION

Two years after surgery for breast cancer, patients show significantly less treatment related upper limb morbidity, perceived disability in ADL and worsening of QOL after SLNB compared with ALND.

Positron emission tomography in patients with breast cancer using 18F-3′-deoxy-3′-fluoro-l-thymidine (18F-FLT)—a pilot study

BACKGROUND

This pilot study investigated the feasibility of (18)F-3'-deoxy-3'-fluoro-l-thymidine ((18)F-FLT) as a positron emission tomography (PET) tracer for the visualisation of breast cancer.

METHODS

Patients with breast cancer underwent (18)F-FLT-PET prior to surgery. The uptake of (18)F-FLT was determined in the primary tumour and in the axilla.

RESULTS

Eight tumours were visualized by (18)F-FLT-PET with a mean uptake value (SUV(mean)) of 1.7 and mean tumour-non-tumour ratio (TNT) of 5.0. In seven patients, axillary lymph-node metastases were found at pathological examinations, however, (18)F-FLT-PET showed uptake in only two large (and clinically evident) lymph-node metastases.

CONCLUSIONS

(18)F-FLT shows uptake in most primary breast tumours and in large axillary lymph-node metastases.

Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients

Background

Several studies have shown adequate sensitivity and specificity of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the detection of metastases from melanoma, but few have addressed its impact on treatment. The aim of this retrospective study was to assess the impact of FDG-PET on treatment of melanoma in three Dutch university medical centres.

Methods

The medical records of 257 patients were reviewed. The indications for FDG-PET and findings were recorded. Unexpected findings of suspected (pre)malignant tumours other than melanoma were assessed. Treatment plans before and after FDG-PET were recorded and analysed to evaluate changes in disease management.

Results

Most scans (71·2 per cent) were requested for staging, mainly to detect distant metastases in patients with stage III disease. Overall, 56 patients (21·8 per cent) were upstaged as a result of PET. In 44 patients (17·1 per cent) treatment was changed, usually from surgery to systemic treatment in patients with stage III disease. Unexpected tumours were detected (mainly colorectal) in 11 patients (4·3 per cent).

Conclusion

FDG-PET is most valuable in patients with stage III melanoma for detection of distant metastases and identification of candidates for surgery and/or systemic treatment. Unexpected FDG-PET findings should not be disregarded, as (pre)malignant, clinically relevant, tumours may be identified.

The quality of communication between parents and adolescent children in the case of parental cancer

BACKGROUND

This study was designed to investigate: (i) parent-adolescent communication in families of cancer patients; (ii) relationships between parent-adolescent communication and posttraumatic stress symptoms (PTSS) in adolescent children; and (iii) associations between parents' illness characteristics and parent-adolescent communication.

PATIENTS AND METHODS

A total of 212 adolescents completed the Impact of Event Scale and Parent-Adolescent Communication Scale.

RESULTS

Adolescents communicated less openly with mothers with cancer than controls with mothers; this was the only significant difference with the reference group. Daughters communicated more openly with ill parents than with healthy parents. More open communication with healthy parents was related to fewer PTSS in daughters. More problem communication with both parents was related to more PTSS in both sons and daughters. Sons reported more problems in communication with ill parents in case of more intensive treatment or recurrent disease. Daughters experienced less open communication with both parents when ill parents received more intensive treatment. Time since diagnosis was not related to parent-adolescent communication. Multivariate analyses showed that communication patterns specifically affected PTSS of daughters. Problem communication with the healthy parent was the strongest predictor of intrusion while problem communication with the ill parents was the strongest predictor of avoidance.

CONCLUSIONS

Parent-adolescent communication in families of cancer patients differs little from that in families not confronted with parental cancer. Problem communication outweighed lack of openness with respect to development of PTSS. Recurrent disease and intensive treatment regimens affected parent-adolescent communication negatively.

Quality of life of testicular cancer survivors and the relationship with sociodemographics, cancer-related variables, and life events

GOALS OF WORK

The aim of this study was to (1) assess the quality of life (QoL) of testicular cancer survivors (TCSs) by comparing them to a reference group; (2) investigate the relationship between the QoL of TCSs and sociodemographics, cancer-related variables, and life events; and (3) identify TCSs at risk for an impaired QoL.

PATIENTS AND METHODS

Of the TCSs approached, 50% (n=354) participated and completed a generic QoL questionnaire (RAND-36) once. Time since completion of treatment varied from 3 months to 24 years.

MAIN RESULTS

(1) TCSs had significantly higher mean scores on the subscales physical functioning (p=0.02) and pain (p=0.001), but lower mean scores on mental health (p=0.04) and vitality (p<0.001) than a reference group of men. The effect sizes of these differences were small to insignificant. (2) Employment status and chronic disease were the main correlates of the QoL of TCSs. Age, negative life events, type of treatment, and the experience of a second cancer event were moderately associated with some subscales as well. (3) The joint burden of unemployment and a chronic disease was the strongest predictor for an impaired functioning.

CONCLUSIONS

On a group level, TCSs experience a good QoL, but a small group appeared to be at risk for an impaired functioning, namely, those who were unemployed and had a chronic disease. The variance explained by the variables studied was low, indicating that more important predictors remain to be identified.

Morbidity after axillary sentinel lymph node biopsy in patients with cutaneous melanoma

AIM

In this study, the short-term and long-term morbidity was assesed after axillary sentinel lymph node biopsy (SLNB) with or without completion axillary lymph node dissection (SLNB/ALND) in patients with cutaneous melanoma.

METHODS

Between 1995 and 2003, 119 axillary SLNBs were performed for cutaneous melanoma. Fifty-eight patients met the inclusion criteria and entered the study.

RESULTS

Forty-four patients underwent SLNB alone and 14 patients underwent axillary lymph node dissection after positive SLNB. Complications after SLNB alone: post-operative bleeding (n=2), seroma (n=1) and slight lymphedema 11%. Complications after SLNB/ALND: wound infections (n=2), seroma (n=5) and slight lymphedema 7%. There were differences between the two groups in short-term complications (p<.001) and functional limitations of the shoulder (p=.011).

CONCLUSION

Axillary SLNB alone had a low complication rate. However, SLNB followed by completion ALND was associated with an increased risk of short- and long-term complications.

[Sentinel lymph node biopsy for melanoma: prognostic value and disadvantages in 300 patients]

OBJECTIVE

The aim of this study was to evaluate the advantages and disadvantages of sentinel lymph node biopsy (SLNB) in patients with cutaneous melanoma.

DESIGN

Descriptive follow-up study.

METHOD

In the period 1995-2004, 300 patients with cutaneous melanoma (Breslow thickness: > or = 1.0 mm) underwent SLNB and, in case of a tumour-positive result, regional lymph node dissection. Results of the SLNB procedure, postoperative complications, follow-up, recurrences, disease-free survival and disease-specific survival were evaluated.

RESULTS

The SLNB detection rate was 99%. 85 patients had a tumour-positive SLNB (28%) and underwent completion regional lymph node dissection; 215 patients underwent SLNB alone. The rate of postoperative complications after SLNB was 7%. With a median follow up of 51 months, the false-negative rate was 11%. The recurrence rate was 23% (SLNB negative: 19%; SLNB positive 34%; p = 0.005). In-transit metastases were found in 4% of the SLNB-negative group and in 20% of the SLNB-positive group (p < 0.001). The 5-year disease-free survival and disease-specific survival rates were 79% and 86%, respectively, in SLNB-negative patients and 57% and 71%, respectively, in SLNB-positive patients. Multivariate analysis showed that the independent prognostic factors for disease-free survival were presence of ulceration (p < 0.001) and SLNB positivity (p < 0.01). Prognostic factors for overall survival were presence of ulceration (p < 0.001) and male sex (p < 0.05), but not the SLNB results. Multivariate analysis also showed that SLNB positivity (p < 0.001) and presence of ulceration (p < 0.01) were independent prognostic factors for developing in-transit metastases.

CONCLUSION

SLNB in patients with cutaneous melanoma is still only of prognostic value since survival benefit is not proven. Disadvantages of SLNB were the false-negative rate, the possibility of an increased risk of in-transit metastases in SLNB-positive patients, and postoperative complications. These must be kept in mind when offering patients SLNB.