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Buja A, Rugge M, Cozzolino C, Dossi F, Zorzi M, Vecchiato A, de Luca G, Del Fiore P, Tropea S, dall’Olmo L, Rossi CR, Boccuzzo G, Mocellin S. Could the mitotic count improve personalized prognosis in melanoma patients? PLoS One 2024; 19:e0302309. [PMID: 38626072 PMCID: PMC11020877 DOI: 10.1371/journal.pone.0302309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/28/2024] [Indexed: 04/18/2024] Open
Abstract
A number of studies have indicated that the mitotic rate may be a predictive factor for poor prognosis in melanoma patients. The aim of this study was to investigate whether the mitotic rate is associated with other prognostic clinical and anatomopathological characteristics. After adjusting for other anatomopathological characteristics, we then verified the prognostic value of the number of mitoses, determining in which population subgroup this variable may have greater prognostic significance on 3-year mortality. The Veneto Cancer Registry (Registro Tumori del Veneto-RTV), a high-resolution population-based dataset covering the regional population of approximately 4.9 million residents, served as the clinical data source for the analysis. Inclusion criteria included all incident cases of invasive cutaneous malignant melanoma recorded in the RTV in 2015 (1,050 cases) and 2017 (1,205 cases) for which the number of mitoses was available. Mitotic classes were represented by Kaplan-Meier curves for short-term overall survival. Cox regression calculated hazard ratios in multivariable models to evaluate the independent prognostic role of different mitotic rate cut-offs. The results indicate that the mitotic rate is associated with other survival prognostic factors: the variables comprising the TNM stage (e.g., tumor thickness, ulceration, lymph node status and presence of metastasis) and the characteristics that are not included in the TNM stage (e.g., age, site of tumor, type of morphology, growth pattern and TIL). Moreover, this study demonstrated that, even after adjusting for these prognostic factors, mitoses per mm2 are associated with higher mortality, particularly in T2 patients. In conclusion, these findings revealed the need to include the mitotic rate in the histological diagnosis because it correlates with the prognosis as an independent factor. The mitotic rate can be used to develop a personalized medicine approach in the treatment and follow-up monitoring of melanoma patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
- Department of Medicine—DIMED, Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Claudia Cozzolino
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Francesca Dossi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Giuseppe de Luca
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Directorate General, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Luigi dall’Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
| | | | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
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2
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Sun J, Wang M, Kan Z. Diagnostic and prognostic risk factors analysis for distant metastasis in melanoma: a population-based study. Eur J Cancer Prev 2024:00008469-990000000-00125. [PMID: 38251671 DOI: 10.1097/cej.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND We aimed to develop tools that could predict the occurrence of distant metastases in melanoma and its prognosis based on clinical and pathological characteristics. MATERIALS AND METHODS We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database of melanoma patients diagnosed between 2010 and 2019. Logistic analyses were performed to identify independent risk factors associated with distant metastasis. Additionally, multivariate Cox analyses were conducted to determine independent prognostic factors for patients with distant metastasis. Two nomograms were established and evaluated with the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Furthermore, we performed a retrospective analysis of melanoma with distant metastasis from our institute between March 2018 and June 2022. RESULTS Of the total 19 396 melanoma patients, 352 (1.8%) had distant metastases at the time of diagnosis. The following clinical and pathological characteristics were identified as independent risk factors for distant metastasis in melanoma: N stage, tumor size, ulceration, mitosis, primary tumor site, and pathological subtype. Furthermore, tumor size, pathological subtype, and radiotherapy were identified as independent prognostic factors. The results of the training and validation cohorts' ROC curves, calibration, DCA, and Kaplan-Meier survival curves demonstrate the effectiveness of the two nomograms. The retrospective study results from our center supported the results from the SEER database. CONCLUSION The clinical and pathological characteristics of melanoma can predict a patient's risk of metastasis and prognosis, and the two nomograms are expected to be effective tools to guide therapy decisions.
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Affiliation(s)
- Junwei Sun
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Mingyu Wang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhisheng Kan
- Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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Kim E, Obermeyer I, Rubin N, Khariwala SS. Prognostic significance of regression and mitotic rate in head and neck cutaneous melanoma. Laryngoscope Investig Otolaryngol 2020; 6:109-115. [PMID: 33614938 PMCID: PMC7883603 DOI: 10.1002/lio2.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/28/2022] Open
Abstract
Importance While regression is a commonly reported microscopic feature of melanoma, its prognostic significance is unclear. Objective To examine the impact of regression on sentinel node status and the likelihood of recurrence in primary cutaneous melanoma of the head and neck. Design Retrospective analysis of 191 adults who underwent surgical management for primary cutaneous melanoma of the head and neck between May 2002 and March 2019. Setting Tertiary academic center. Participants Patients appropriate for the study were identified by the Academic Health Center Information Exchange using a list of current procedural terminology codes. One hundred and ninety‐one cases of invasive melanoma of the head and neck were included from 830 patients identified. Clinical features assessed for each patient included age, sex, location of primary lesion, date of diagnosis, and current disease status (alive with or without disease). Histologic features assessed were histological melanoma subtype (nodular vs non‐nodular), Breslow thickness, Clark level, presence/absence of ulceration, mitotic rate per square millimeter, and regression. If applicable, sentinel lymph node biopsy (SLNB) status, date of recurrence, interval treatments, and date of death related to melanoma were recorded. Exclusion criteria included melanoma outside the anatomic parameters of head and neck, ocular or choroidal melanoma, mucosal melanoma, metastatic melanoma to the head or neck with no known primary tumor, melanoma of the head or neck with no surgical intervention, and non‐melanoma skin cancers of the head and neck. Intervention/Exposure Surgery for cutaneous melanoma of the head and neck. Main Outcome(s) and Measure(s) The association between presence of regression and Breslow thickness, sentinel node status, and recurrence. Results Of the 191 patients identified, 30.9% were female and 69.1% were male with a mean age at diagnosis of 62.6 (range 20‐97) years. Mean Breslow thickness was 1.2 mm in those with regression and 2.0 mm in those without regression. In patients with regression, 17.6% had a positive sentinel node, and 13.0% experienced a recurrence. In patients without regression, 26.5% had a positive sentinel node, and 31.4% experienced a recurrence. When adjusted for other factors above, regression was not associated with positive sentinel node (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.13‐2.00) or recurrence (OR = 0.33, CI = 0.07‐1.01). Mitotic rate >2 was associated with recurrence (OR = 2.71, CI = 1.11‐6.75, P = .03). Conclusions and Relevance Patients with presence of regression had thinner melanomas and trended toward decreased rates of sentinel node positivity and recurrence, suggesting regression may not be a negative prognostic indicator in patients with cutaneous melanoma of the head and neck.
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Affiliation(s)
- Elizabeth Kim
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Isaac Obermeyer
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center University of Minnesota Minneapolis Minnesota USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
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Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2018; 80:208-250. [PMID: 30392755 DOI: 10.1016/j.jaad.2018.08.055] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
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Affiliation(s)
- Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona
| | - David E Elder
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Oliver J Wisco
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Toyin Lamina
- American Academy of Dermatology, Rosemont, Illinois
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5
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Evans JL, Vidri RJ, MacGillivray DC, Fitzgerald TL. Tumor mitotic rate is an independent predictor of survival for nonmetastatic melanoma. Surgery 2018; 164:589-593. [PMID: 29929753 DOI: 10.1016/j.surg.2018.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/04/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tumor mitotic rate is a known prognostic variable in Stage I melanoma; however, its importance is unclear in Stages II and III. METHODS Patients diagnosed with nonmetastatic cutaneous melanoma from 2010 to 2014 were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. RESULTS Of a total of 71,235 patients, the majority were white (94.7%), male (58.5%), and had a Stage I tumor (79.0%). On univariable analysis, 5-year disease-specific survival decreased with each increasing tumor mitotic rate category of 0-3, 4-10, and >10 mitoses/mm2 (Stage I 98.3%, 90.9%, 79.7%; Stage II 86.1%, 74.2%, 72.9%; and Stage III 72.5%, 58.6%, 49.7%). In multivariable models, tumor mitotic rate as both a continuous and categorical variable was associated with disease-specific survival for Stages I-III melanoma. Each unit increase in tumor mitotic rate increased the risk of death by 23% in Stage I, 5% in Stage II, and 3% in Stage III. Compared with the 0-3 tumor mitotic rate category, the risk of disease-specific mortality increased for tumors in the 4-10 and >10 categories for Stage I (RR 3.07 and 6.74, P < .0001), Stage II (RR 1.37 and 1.62, P = .0002), and Stage III (RR 1.24 and 1.35, P = .0004). CONCLUSION In this cohort study, tumor mitotic rate is an independent predictor of survival for localized melanoma.
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Affiliation(s)
- Jessica L Evans
- Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland
| | - Roberto J Vidri
- Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland; St. Mary's Regional Medical Center, Surgery, Lewiston, ME
| | - Dougald C MacGillivray
- Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland
| | - Timothy L Fitzgerald
- Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland.
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6
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Laks S, Meyers MO, Deal AM, Frank JS, Stitzenberg KB, Yeh JJ, Thomas NE, Ollila DW. Tumor Mitotic Rate and Association with Recurrence in Sentinel Lymph Node Negative Stage II Melanoma Patients. Am Surg 2017. [DOI: 10.1177/000313481708300934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tumor mitotic rate (TMR) is a known prognostic variable in thin melanoma patients. Its significance in stage II melanoma patients is yet to be demonstrated. Retrospective analysis of a prospective melanoma database from 9/1997 to 7/2015 was performed. All stage II melanoma, with documented TMR, and six months of follow-up were included. We evaluated the association of clinicopathologic variables, TMR, as a continuous and categorical variable with recurrence-free survival (RFS) and overall survival (OS) using Cox proportional hazards modeling. We used a statistical model, X-tile, to develop optimal categorizations of TMR. A total of 265 patient characteristics are included in this study. Recurrences occurred in 82 (30.9%) patients, including 5 local, 41 regional, and 36 distant patients. In multivariate model, ulceration, Breslow, and continuous TMR were associated with worse RFS\OS. Continuous TMR demonstrated worse RFS (hazards ratio [HR] 1.02 (1.00–1.05)) and OS (HR 1.02 (1.00–1.04)), whereas dichotomized TMR (≥1 vs <1) was not significant. TMR >10.4 mitoses/mm2 has a 5-year RFS\OS of 27.2 and 44.3 per cent, respectively, compared with 57.4 and 71.4 per cent, respectively, for TMR <3.2 mitoses/mm2. Continuous TMR predicts incidence of recurrence in stage II melanoma. We propose a new categorization method developed by statistical modeling for optimal stratification that may guide surveillance for this disparate patient population.
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Affiliation(s)
- Shachar Laks
- Department of Surgery, Division of Surgical Oncology
| | | | | | | | | | - Jen Jen Yeh
- Department of Surgery, Division of Surgical Oncology
- Lineberger Comprehensive Cancer Center, and
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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7
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Ribero S, Osella-Abate S, Pasquali S, Rossi CR, Borgognoni L, Piazzalunga D, Solari N, Schiavon M, Brandani P, Ansaloni L, Ponte E, Silan F, Sommariva A, Bellucci F, Macripò G, Quaglino P. Prognostic Role of Multiple Lymphatic Basin Drainage in Sentinel Lymph Node-Negative Trunk Melanoma Patients: A Multicenter Study from the Italian Melanoma Intergroup. Ann Surg Oncol 2016; 23:1708-15. [PMID: 26597362 DOI: 10.1245/s10434-015-4973-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Indexed: 12/16/2023]
Abstract
BACKGROUND Multiple lymphatic basin drainage (MLBD) is frequently observed in patients with trunk melanoma undergoing sentinel lymph node (SLN) biopsy. Conflicting data regarding the prognostic association of MLBD in SLN-negative patients have been reported. This study aimed to investigate the prognostic role of MLBD in patients with negative SLN biopsy. METHODS Retrospective data from 656 melanoma patients who underwent a SLN biopsy (1991-2012) at six Italian centers were gathered in a multicenter database. MLBD was defined as lymphoscintigraphic and intraoperative identification of an SLN in more than one nodal basin. Clinical and pathologic variables were recorded and analyzed for their impact on survival. RESULTS SLN-negative patients with MLBD were at lower risk of melanoma recurrence [hazard ratio (HR) 0.73, P = 0.05) and melanoma-related death (HR 0.68, P = 0.001) independent of common staging features. Multivariable Cox analyses of disease-free interval (DFI) and disease-specific survival (DSS) showed that MLBD maintained a favorable role and ulceration an unfavorable role. Histologic regression was independently associated only with DFI. When survival was stratified according to presence of MLBD, histologic regression and Breslow thickness <2 mm were associated with improved DFI (5-year DFI: 96.9 vs. 66,1 %, respectively; HR 0.48, P < 0.001) and DSS (5-year DSS: 96.7 vs. 71.8 %, respectively; HR 0.52, P = 0.005) compared to patients without these three favorable parameters. CONCLUSIONS Patients with negative SLN biopsy results have better prognosis when two or more lymphatic basins are identified and analyzed. Further research is required to investigate the mechanisms behind this evidence.
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Affiliation(s)
- Simone Ribero
- Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy.
- Oncological Department, Dermatologic Surgery Department, Citta' della Salute e della Scienza di Torino Hospital, Turin, Italy.
| | - Simona Osella-Abate
- Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Sandro Pasquali
- Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy
| | - Carlo Riccardo Rossi
- Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy
- Department of Surgery, Oncology, and Gastroenterology, Surgery Branch, University of Padova, Padua, Italy
| | - Lorenzo Borgognoni
- Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy
| | | | - Nicola Solari
- Division of Surgical Oncology, IRCC-San Martino Hospital-National Cancer Institute of Genoa, Genoa, Italy
| | - Mauro Schiavon
- Plastic Surgery Department, Santa Maria della Misericordia di Udine Hospital, Udine, Italy
| | - Paola Brandani
- Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy
| | - Luca Ansaloni
- Unit of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Erica Ponte
- Division of Surgical Oncology, IRCC-San Martino Hospital-National Cancer Institute of Genoa, Genoa, Italy
| | - Francesco Silan
- Plastic Surgery Department, Santa Maria della Misericordia di Udine Hospital, Udine, Italy
| | - Antonio Sommariva
- Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy
| | - Francesco Bellucci
- Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy
| | - Giuseppe Macripò
- Oncological Department, Dermatologic Surgery Department, Citta' della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
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8
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Duprat JP, Brechtbülh ER, Costa de Sá B, Enokihara M, Fregnani JH, Landman G, Maia M, Riccardi F, Belfort FA, Wainstein A, Moredo LF, Steck H, Brandão M, Moreno M, Miranda E, Santos IDDO. Absence of Tumor-Infiltrating Lymphocyte Is a Reproducible Predictive Factor for Sentinel Lymph Node Metastasis: A Multicenter Database Study by the Brazilian Melanoma Group. PLoS One 2016; 11:e0148160. [PMID: 26859408 PMCID: PMC4747578 DOI: 10.1371/journal.pone.0148160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
Abstract
Aims The aim of this study is to confirm the function of tumor-infiltrating lymphocytes (TILs) in sentinel lymph node (SLN) metastasis. Materials and Methods This retrospective study included 633 patients with invasive melanoma who underwent sentinel lymph node biopsy in 7 referral centers certified by the Brazilian Melanoma Group. Independent risk factors of sentinel node metastasis (SNL) were identified by multiple logistic regression. Results SLN metastasis was detected in 101 of 633 cases (16.1%) and in 93 of 428 patients (21.7%) when melanomas ≤ 1mm were excluded. By multiple logistic regression, the absence of TILs was as an independent risk factor of SLN metastasis (OR = 1.8; 95%CI: 1.1–3.0), in addition to Breslow index (greater than 2.00 mm), lymph vascular invasion, and presence of mitosis. Conclusion SLNB can identify patients who might benefit from immunotherapy, and the determination of predictors of SLNB positivity can help select the proper population for this type of therapy. The absence of TILs is a reproducible parameter that can predict SLNB positivity in melanoma patients, since this study was made with several centers with different dermatopathologists.
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Affiliation(s)
| | | | | | - Mauro Enokihara
- Medical School, São Paulo Federal University, São Paulo, Brazil
| | | | - Gilles Landman
- Medical School, São Paulo Federal University, São Paulo, Brazil
| | - Marcus Maia
- Santa Casa de Misericórdia, São Paulo, Brazil
| | | | | | | | | | | | | | - Marcelo Moreno
- Medical School, Community University of Chapecó Region, Chapecó, Brazil
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9
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Speijers MJ, Bastiaannet E, Sloot S, Suurmeijer AJH, Hoekstra HJ. Tumor mitotic rate added to the equation: melanoma prognostic factors changed? : a single-institution database study on the prognostic value of tumor mitotic rate for sentinel lymph node status and survival of cutaneous melanoma patients. Ann Surg Oncol 2015; 22:2978-87. [PMID: 25605514 DOI: 10.1245/s10434-014-4349-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to investigate the predictive value of the tumor mitotic rate per mm(2) (TMR) for sentinel lymph node (SLN) status and survival in intermediate and thick cutaneous melanoma. METHODS Patients treated for stage I and II melanoma with wide local excision and SLN biopsy between May 1995 and May 2013 were analyzed. In case of insufficient data regarding TMR, pathology slides were reanalyzed. Prognostic factors for SLN status and survival were analyzed with the emphasis on TMR, which was analyzed as a continuous variable, dichotomized (median value) and categorized by two methods. RESULTS The study analyzed 453 patients with complete TMR data. The median Breslow thickness was 2.20 mm, and 31.8 % of patients had tumor-positive sentinel lymph node biopsies (SLNBs). In the univariate analysis, TMR was associated with tumor-positive SLNB. This association was not significant in the multivariate analysis. Breslow thickness, primary tumor location on trunk and legs, and younger age were associated with tumor-positive SNLB. At a median follow-up of 47 months, 119 patients (26.3 %) had recurrent disease, and 92 (20.3 %) had died of melanoma. In the univariate analysis, TMR could be established as a significant prognostic factor for disease-free and disease-specific survival, but not in the multivariate analyses. Breslow thickness, ulcerated melanoma, and tumor-positive SLNB were significant prognostic factors for survival. CONCLUSION The study was unable to establish TMR as an independent prognostic factor associated with the presence of SLN metastasis. Regarding survival, increasing TMR showed a strong association with decreased survival in the univariate analysis, but this association was rendered nonsignificant by the importance of Breslow thickness and ulceration status in the multivariate model.
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Affiliation(s)
- M J Speijers
- Division of Surgical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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10
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Baker JJ, Meyers MO, Deal AM, Frank JF, Stitzenberg KB, Ollila DW. Prognostic significance of tumor mitotic rate in T2 melanoma staged with sentinel lymphadenectomy. J Surg Oncol 2015; 111:711-5. [DOI: 10.1002/jso.23880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 12/06/2014] [Indexed: 12/29/2022]
Affiliation(s)
| | - Michael O. Meyers
- Division of Surgical Oncology; Department of Surgery; University of North Carolina-Chapel Hill; North Carolina
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
- Biostatistics Core Facility; University of North Carolina-Chapel Hill; North Carolina
| | - Jill F. Frank
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
| | - Karyn B. Stitzenberg
- Division of Surgical Oncology; Department of Surgery; University of North Carolina-Chapel Hill; North Carolina
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
| | - David W. Ollila
- Division of Surgical Oncology; Department of Surgery; University of North Carolina-Chapel Hill; North Carolina
- Lineberger Comprehensive Cancer Center; University of North Carolina-Chapel Hill; North Carolina
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Betti R, Santambrogio R, Cerri A, Vergani R, Moneghini L, Menni S. Observational study on the mitotic rate and other prognostic factors in cutaneous primary melanoma arising from naevi and from melanoma de novo. J Eur Acad Dermatol Venereol 2014; 28:1738-41. [DOI: 10.1111/jdv.12395] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/10/2014] [Indexed: 11/27/2022]
Affiliation(s)
- R. Betti
- Dermatologic Clinic; Department of Health Sciences; Università degli Studi di Milano; Milan Italy
| | - R. Santambrogio
- Department of Hepato-bilio-pancreatic and Digestive Surgery; Università degli Studi di Milano; Milan Italy
| | - A. Cerri
- Dermatologic Clinic; Department of Health Sciences; Università degli Studi di Milano; Milan Italy
| | - R. Vergani
- Dermatologic Clinic; Department of Health Sciences; Università degli Studi di Milano; Milan Italy
| | - L. Moneghini
- Department of Health Sciences; Division of Pathology; University of Milan; Milan Italy
| | - S. Menni
- Dermatologic Clinic; Department of Health Sciences; Università degli Studi di Milano; Milan Italy
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Mahiques Santos L, Oliver Martinez V, Alegre de Miquel V. Biopsia de ganglio centinela en melanoma. Valor pronóstico y correlación con el índice mitótico. Experiencia en un hospital terciario. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:60-8. [DOI: 10.1016/j.ad.2013.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/11/2013] [Accepted: 07/14/2013] [Indexed: 11/29/2022] Open
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Sentinel Lymph Node Status in Melanoma: Prognostic Value in a Tertiary Hospital and Correlation with Mitotic Activity. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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15
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Jones EL, Jones TS, Pearlman NW, Gao D, Stovall R, Gajdos C, Kounalakis N, Gonzalez R, Lewis KD, Robinson WA, McCarter MD. Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result. JAMA Surg 2013; 148:456-61. [PMID: 23325294 DOI: 10.1001/jamasurg.2013.1335] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result. DESIGN Retrospective chart review of a prospectively created database of patients with cutaneous melanoma. SETTING Tertiary university hospital. PATIENTS A total of 515 patients with melanoma underwent a sentinel lymph node biopsy without evidence of metastatic disease between 1996 and 2008. MAIN OUTCOME MEASURES Time to recurrence and overall survival. RESULTS Of 515 patients, 83 (16%) had a recurrence of melanoma at a median of 23 months during a median follow-up of 61 months (range, 1-154 months). Of these 83 patients, 21 had melanoma that metastasized in the studied nodal basin for an in-basin false-negative rate of 4.0%. Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs 1.8 mm; P < .01) that were more likely to be ulcerated (32.5% vs 13.5%; P < .001) than those without recurrence. The primary melanoma of patients with recurrence was more likely to be located in the head and neck region compared with all other locations combined (31.8% vs 11.7%; P < .001). Median survival following a recurrence was 21 months (range, 1-106 months). Favorable characteristics associated with lower risk of recurrence included younger age at diagnosis (mean, 49 vs 57 years) and female sex (9% vs 21% for males; P < .001). CONCLUSION Overall, recurrence of melanoma (16%) after a negative sentinel lymph node biopsy result was similar to that in previously reported studies with an in-basin false-negative rate of 4.0%. Lesions of the head and neck, the presence of ulceration, increasing Breslow thickness, older age, and male sex are associated with increased risk of recurrence, despite a negative sentinel lymph node biopsy result.
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Affiliation(s)
- Edward L Jones
- Department of Surgery, University of Colorado Denver, Aurora, CO 80045, USA
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Mitotic rate in melanoma: prognostic value of immunostaining and computer-assisted image analysis. Am J Surg Pathol 2013; 37:882-9. [PMID: 23629443 DOI: 10.1097/pas.0b013e31827e50fa] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The prognostic value of mitotic rate in melanoma is increasingly recognized, particularly in thin melanoma in which the presence or absence of a single mitosis/mm can change staging from T1a to T1b. Still, accurate mitotic rate calculation (mitoses/mm) on hematoxylin and eosin (H&E)-stained sections can be challenging. Antimonoclonal mitotic protein-2 (MPM-2) and antiphosphohistone-H3 (PHH3) are 2 antibodies reported to be more mitosis-specific than other markers of proliferation such as Ki-67. We used light microscopy and computer-assisted image analysis software to quantify MPM-2 and PHH3 staining in melanoma. We then compared mitotic rates by each method with conventional H&E-based mitotic rate for correlation with clinical outcomes. Our study included primary tissues from 190 nonconsecutive cutaneous melanoma patients who were prospectively enrolled at New York University Langone Medical Center with information on age, gender, and primary tumor characteristics. The mitotic rate was quantified manually by light microscopy of corresponding H&E-stained, MPM-2-stained, and PHH3-stained sections. Computer-assisted image analysis was then used to quantify immunolabeled mitoses on the previously examined PHH3 and MPM-2 slides. We then analyzed the association between mitotic rate and both progression-free and melanoma-specific survival. Univariate analysis of PHH3 found significant correlation between increased PHH3 mitotic rate and decreased progression-free survival (P=0.04). Computer-assisted image analysis enhanced the correlation of PHH3 mitotic rate with progression-free survival (P=0.02). Regardless of the detection method, neither MPM-2 nor PHH3 offered significant advantage over conventional H&E determination of mitotic rate.
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Abstract
In this chapter, we try to debate two of the most several controversial points about melanoma: the role of the ultraviolet (UV) ray exposure and the position of the sentinel node biopsy in the dermatological daily activity. It has been demonstrated as a direct relationship between UV exposure and the risk of developing melanoma, but it is also true that a chronic continuous UV ray exposure can develop a protective action. Nodal evaluation is one of the most important prognostic indicators to be considered for the patient outcome. The aims for which sentinel node biopsy is so often adopted can be summarized in three points: a detailed nodal staging, a regional disease control, and a possible overall improved survival. At present, many authors do not think that it let the overall survival grow; therefore, they suggest its use only to stage regional lymph nodes and accurately identify patients who could benefit through an early complete regional lymphadenectomy.
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Affiliation(s)
- Torello Lotti
- Dermatology Division, University of Rome G. Marconi, Rome, Italy.
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Risk Factors for the Development of Locoregional Cutaneous Metastases as the Sole Form of Recurrence in Patients With Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Burton AL, Egger ME, Gilbert JE, Stromberg AJ, Hagendoorn L, Martin RC, Scoggins CR, McMasters KM, Callender GG. Assessment of mitotic rate reporting in melanoma. Am J Surg 2012; 204:969-74; discussion 974-5. [DOI: 10.1016/j.amjsurg.2012.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 10/27/2022]
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Rose AM, Hough M, Munnoch DA. Tumour mitotic rate—a poor predictor of sentinel lymph node status in cutaneous melanoma: should we select using staging criteria? EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Risk factors for the development of locoregional cutaneous metastases as the sole form of recurrence in patients with melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2012; 104:53-60. [PMID: 23010018 DOI: 10.1016/j.ad.2012.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/07/2012] [Accepted: 05/13/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND While locoregional cutaneous metastases (in transit and satellite) in melanoma have received little attention from researchers to date, they have pathogenic and prognostic features that distinguish them from other forms of locoregional recurrence. Identifying predictors of these metastases would be of great value for their prevention, early diagnosis, and treatment. The aim of this study was to identify the risk factors associated with locoregional cutaneous metastases as the first form of recurrence in the metastatic progression of melanoma. MATERIAL AND METHODS Between 2000 and 2010, we prospectively collected the data of 1327 patients diagnosed with stage I and II melanoma. During follow up, 112 patients (8.4%) developed metastases. Of these, 36 had exclusively locoregional cutaneous metastases. The clinical and histological characteristics of this subgroup were evaluated. RESULTS In the univariate analysis, significant predictors were patient age, primary tumor thickness, site, ulceration, mitotic index, and histological type. After multivariate analysis, the independent risk factors were tumor thickness (risk ratio [RR] 5.6; 95% CI: 2.7-11.5) and the location of the primary tumor on the lower limbs (RR 3.4; 95% CI: 1.0-11.5), on the head or neck (RR 4.8; 95% IC: 1.7-13.5), or in acral sites (RR 6.7; 95% IC: 2.2-20.8). CONCLUSION Patients who have melanomas with a Breslow thickness of more than 2mm located on the lower limbs, head, neck, or acral sites have a higher risk of developing locoregional cutaneous metastases. These findings could be useful in the design of future guidelines for the monitoring and management of melanoma.
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Callender GG, Gershenwald JE, Egger ME, Scoggins CR, Martin RC, Schacherer CW, Edwards MJ, Urist MM, Ross MI, Stromberg AJ, McMasters KM. A Novel and Accurate Computer Model of Melanoma Prognosis for Patients Staged by Sentinel Lymph Node Biopsy: Comparison with the American Joint Committee on Cancer Model. J Am Coll Surg 2012; 214:608-17; discussion 617-9. [DOI: 10.1016/j.jamcollsurg.2011.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 12/29/2022]
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Messeguer F, Agustí-Mejías A, Traves V, Requena C, Alegre V, Guillén C, Oliver V, Nagore E. Mitotic rate and subcutaneous involvement are prognostic factors for survival after recurrence in patients with only locoregional skin metastasis as the first site of recurrence from cutaneous melanoma. J Eur Acad Dermatol Venereol 2012; 27:436-41. [DOI: 10.1111/j.1468-3083.2012.04454.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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