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Cheng TW, Hartsough E, Giubellino A. Sentinel lymph node assessment in melanoma: current state and future directions. Histopathology 2023; 83:669-684. [PMID: 37526026 DOI: 10.1111/his.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
Assessment of sentinel lymph node status is an important step in the evaluation of patients with melanoma for both prognosis and therapeutic management. Pathologists have an important role in this evaluation. The methodologies have varied over time, from the evaluation of dimensions of metastatic burden to determination of the location of the tumour deposits within the lymph node to precise cell counting. However, no single method of sentinel lymph node tumour burden measurement can currently be used as a sole independent predictor of prognosis. The management approach to sentinel lymph node-positive patients has also evolved over time, with a more conservative approach recently recognised for selected cases. This review gives an overview of past and current status in the field with a glimpse into future directions based on prior experiences and clinical trials.
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Affiliation(s)
- Tiffany W Cheng
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Emily Hartsough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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2
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Ziętek M, Teterycz P, Wierzbicki J, Jankowski M, Las-Jankowska M, Zegarski W, Piekarski J, Nejc D, Drucis K, Cybulska-Stopa B, Łobaziewicz W, Galwas K, Kamińska-Winciorek G, Zdzienicki M, Sryukina T, Ziobro A, Kluz A, Czarnecka AM, Rutkowski P. The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study. Cancers (Basel) 2023; 15:2667. [PMID: 37345002 PMCID: PMC10216007 DOI: 10.3390/cancers15102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In melanoma treatment, an approach following positive sentinel lymph node biopsy (SLNB) has been recently deescalated from completion lymph node dissection (CLND) to active surveillance based on phase III trials data. In this study, we aim to evaluate treatment strategies in SLNB-positive melanoma patients in real-world practice. METHODS Five-hundred-fifty-seven melanoma SLNB-positive patients from seven comprehensive cancer centers treated between 2017 and 2021 were included. Kaplan-Meier methods and the Cox Proportional-Hazards Model were used for analysis. RESULTS The median follow-up was 25 months. Between 2017 and 2021, the percentage of patients undergoing CLND decreased (88-41%), while the use of adjuvant treatment increased (11-51%). The 3-year OS and RFS rates were 77.9% and 59.6%, respectively. Adjuvant therapy prolonged RFS (HR:0.69, p = 0.036)), but CLND did not (HR:1.22, p = 0.272). There were no statistically significant differences in OS for either adjuvant systemic treatment or CLND. Lower progression risk was also found, and time-dependent hazard ratios estimation in patients treated with systemic adjuvant therapy was confirmed (HR:0.20, p = 0.002 for BRAF inhibitors and HR:0.50, p = 0.015 for anti-PD-1 inhibitors). CONCLUSIONS Treatment of SLNB-positive melanoma patients is constantly evolving, and the role of surgery is currently rather limited. Whether CLND has been performed or not, in a group of SLNB-positive patients, adjuvant systemic treatment should be offered to all eligible patients.
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Affiliation(s)
- Marcin Ziętek
- Department of Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland;
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.Z.); (A.Z.); (A.M.C.); (P.R.)
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Jędrzej Wierzbicki
- Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland;
- Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - Michał Jankowski
- Chair of Surgical Oncology, Collegium Medicum Nicolaus Copernicus University, Oncology Center—Prof Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (W.Z.)
| | - Manuela Las-Jankowska
- Chair of Surgical Oncology, Collegium Medicum Nicolaus Copernicus University, Oncology Center—Prof Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (W.Z.)
| | - Wojciech Zegarski
- Chair of Surgical Oncology, Collegium Medicum Nicolaus Copernicus University, Oncology Center—Prof Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (W.Z.)
| | - Janusz Piekarski
- Department of Surgical Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.P.); (D.N.)
| | - Dariusz Nejc
- Department of Surgical Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.P.); (D.N.)
- Nicolaus Copernicus Multidisciplinary Center for Oncology and Traumatology, 93-513 Lodz, Poland
| | - Kamil Drucis
- Department of Surgical Oncology, Gdansk Medical University, 80-210 Gdansk, Poland
| | - Bożena Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Cracow, Poland;
| | - Wojciech Łobaziewicz
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Cracow, Poland;
| | - Katarzyna Galwas
- 2nd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Grażyna Kamińska-Winciorek
- Department of Bone Marrow Transplantation and Onco-Hematology, Skin Cancer and Melanoma Team, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.Z.); (A.Z.); (A.M.C.); (P.R.)
| | - Tatsiana Sryukina
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.Z.); (A.Z.); (A.M.C.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna Ziobro
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.Z.); (A.Z.); (A.M.C.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Agnieszka Kluz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.Z.); (A.Z.); (A.M.C.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.Z.); (A.Z.); (A.M.C.); (P.R.)
- Department of Experimental Pharmacology, Mossakowski Medical Research Centers, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland (M.Z.); (A.Z.); (A.M.C.); (P.R.)
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Jakub JW, Weaver AL, Meves A. Association of tumor molecular factors with in-transit metastasis in primary cutaneous melanoma. Int J Dermatol 2022; 61:1117-1123. [PMID: 35246838 PMCID: PMC9391269 DOI: 10.1111/ijd.16141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/19/2021] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In-transit metastases (ITM) are a form of locoregional relapse representing intralymphatic metastatic spread and occur in approximately 4-9% of patients with melanoma >1 mm Breslow thickness. Our objective was to evaluate a combination of clinicopathologic risk factors and gene expression biomarkers predictive of ITM risk. METHODS We used PCR to quantify gene expression in diagnostic biopsy tissue across a prospectively designed archival cohort of 854 consecutive thin and intermediate thickness primary cutaneous melanomas. The outcome of interest was ITM >90 days after a melanoma diagnosis. Cox proportional hazard models were fit to estimate each clinicopathologic and molecular characteristic's association with the risk of ITM. RESULTS The 5-year cumulative incidence of ITM was 3.2%. Clinical factors univariately associated with an increased risk of ITM were older age, greater Breslow thickness, greater mitotic rate, lower extremity location, ulceration, and a positive SLN biopsy. Of 108 genes tested, five were significantly upregulated and five significantly downregulated when evaluated in Cox models adjusted for age, Breslow thickness, mitotic rate, and lower extremity location. Among the upregulated genes, the strongest association was observed for interleukin-8 (IL8). CONCLUSION A subset of gene expression biomarkers was identified as independently associated with the risk of ITM after adjusting for key covariates. Once sufficiently validated, our results may lead the way to regional therapy trials for a small, selected group of high-risk patients.
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Affiliation(s)
- James W. Jakub
- Department of Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Amy L. Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Ramiscal JAB, Stern SL, Wilson AK, Lorimer PD, Lee NA, Goldfarb MR, Foshag LJ, Fischer TD. Does Residual Invasive Disease in Wide Local Excision after Diagnosis with Partial Biopsy Technique Influence Survival in Melanoma? Matched-Pair Analysis of Multicenter Selective Lymphadenectomy Trial I and II. J Am Coll Surg 2022; 235:49-59. [PMID: 35703962 DOI: 10.1097/xcs.0000000000000263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current guidelines recommend excisional/complete biopsy for melanoma diagnosis, owing to high rates of residual disease found at wide local excision (WLE) after partial biopsy techniques. We sought to determine any survival disadvantage associated with the presence of residual invasive melanoma in the WLE after diagnosis with a partial biopsy technique. STUDY DESIGN Data were examined from Multicenter Selective Lymphadenectomy Trials I and II (MSLT-I and -II), 2 large melanoma trials. Patients diagnosed with excisional/complete biopsy were excluded. Clinicopathologic characteristics, melanoma-specific survival (MSS), distant disease-free survival (DDFS), and disease-free survival (DFS) of those with residual invasive melanoma in the definitive WLE and those with no residual melanoma were compared. Matched pairing was used to reduce variability between groups. RESULTS From 1994 through 2014, 3,939 patients were enrolled in these trials and 874 (22%) were diagnosed using partial biopsy techniques. Of these, 399 (46%) had residual tumor in the WLE. Only 6 patients had residual tumor in their WLE resulting in T-upstaging of their tumor. Match-pairing formed two cohorts (1:1) of patients with and without residual invasive tumor after WLE. A total of 514 patients were paired; 288 (56%) males, 148 (28.8%) aged 60 or older, 192 (37.4%) with truncal melanomas, 214 (41.6%) had Breslow thickness 2 mm or greater, and 376 (73.2%) had positive sentinel nodes. Kaplan-Meier analysis showed no statistical difference in 10-year MSS (73.6% ± 3.3% vs 73.9% ± 3.7%, p = 0.891), DDFS (68.7% ± 3.4% vs 65.3% ± 4.0%, p = 0.548), or DFS (59.6% ± 3.7% vs 59.4% ± 3.9%, p = 0.783). CONCLUSIONS Survival in patients with primary melanoma does not appear to be worse in patients who undergo a partial biopsy technique and are later found to have residual invasive tumor in the WLE specimen.
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Affiliation(s)
- Judi Anne B Ramiscal
- From Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA
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Arenbergerova M, Lallas A, Nagore E, Rudnicka L, Forsea AM, Pasek M, Meier F, Peris K, Olah J, Posch C. Position statement of the EADV Melanoma Task Force on recommendations for the management of cutaneous melanoma patients during COVID-19. J Eur Acad Dermatol Venereol 2021; 35:e427-e428. [PMID: 33780557 PMCID: PMC8251426 DOI: 10.1111/jdv.17252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - A Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - A M Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania.,Oncologic Dermatology Department, Elias University Hospital Bucharest, Bucharest, Romania
| | - M Pasek
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - F Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany.,Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - K Peris
- UOC di Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dermatologia Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - J Olah
- Department of Oncotherapy, Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - C Posch
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany.,Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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6
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Impact of the time interval between primary melanoma excision and sentinel node biopsy: A systematic review and meta-analysis. J Am Acad Dermatol 2021; 85:128-134. [PMID: 33465429 DOI: 10.1016/j.jaad.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obtaining a sentinel lymph node biopsy (SLNB) specimen is a standard staging procedure in the management of cutaneous melanoma. However, there is no consensus on the safe time interval between the primary melanoma biopsy procedure and the SLNB procedure. OBJECTIVE We evaluated the association between time from biopsy to SLNB and patients' outcomes for melanoma. METHODS We performed this systematic review and meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Six retrospective studies were included. Nine thousand seven hundred five patients were identified, of which 4383 underwent a SNLB procedure at a time interval defined as early and 4574 at an interval defined as late. A combined hazard ratio of 1.25 (95% confidence interval [CI] 0.92-1.68) was determined, and there was high heterogeneity (I2 = 83%; P = .002) of the SLNB time interval on melanoma-specific survival. The combined HR for disease-free survival was 1.05 (95% CI 0.95-1.15), with low heterogeneity (I2 = 9%; P = .36). Regarding overall survival, a combined HR of 1.25 (95% CI 0.92-1.70) was found, with low heterogeneity (I2 = 37%; P = .2). LIMITATIONS There is heterogeneity between some studies. CONCLUSION There are no significant differences in patient outcome between a short interval versus a long interval between the primary biopsy procedure and obtaining a SNLB specimen.
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Gambichler T, Bünnemann H, Scheel CH, Bechara FG, Stücker M, Stockfleth E, Becker JC. Does very early timing of lymph node surgery after resection of the primary tumour improve the clinical outcome of patients with melanoma? Clin Exp Dermatol 2020; 45:1011-1018. [PMID: 32422686 DOI: 10.1111/ced.14291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with cutaneous melanoma (CM), the time span between resection of the primary tumour and sentinel lymph node biopsy (SLNB) as well as the subsequent interval between SLNB and complete lymph node dissection (CLND) varies greatly. AIM To determine whether very early timing of SLNB after resection of the primary tumour, or timing of CLND after SLNB affect the clinical outcome of patients with CM, compared with longer time intervals. METHODS We compared the time spans between complete resection of the primary tumour and SLNB, and the interval between SLNB and CLND in a cohort of 896 patients with melanoma who had undergone SLNB. An interval between primary resection and SLNB or between SLNB and CLND of up to 7 days was classified as very early (VE-SLNB and VE-CLND, respectively). This time span was compared with intervals of > 7 days. Univariate and multivariate statistics were performed. RESULTS VE-SLNB was significantly associated with the presence of micrometastases. However, this was probably due to tumour thickness being significantly higher in patients with VE-SLNB compared with patients with later SLNB. Importantly, VE-SLNB was not significantly associated with disease relapse and VE-CLND was not associated with melanoma-specific death. CONCLUSIONS VE-SLNB and VE-CLND neither improved nor worsened the clinical outcome of patients. Thus, timing of SLNB and CLND has no influence on the overall clinical outcome of patients with melanoma. Our findings support the rational planning of lymph node surgery after resection of the primary tumour and provide help for effective patient counselling.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - H Bünnemann
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - C H Scheel
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - F G Bechara
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - M Stücker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
| | - E Stockfleth
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
| | - J C Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
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Eggermont AMM, Bellomo D, Arias-Mejias SM, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Murphree DH, Pittelkow MR, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, Rentroia-Pacheco B, Wever R, van Vliet MH, Dwarkasing J, Meves A. Identification of stage I/IIA melanoma patients at high risk for disease relapse using a clinicopathologic and gene expression model. Eur J Cancer 2020; 140:11-18. [PMID: 33032086 PMCID: PMC7655519 DOI: 10.1016/j.ejca.2020.08.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/09/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Patients with stage I/IIA cutaneous melanoma (CM) are currently not eligible for adjuvant therapies despite uncertainty in relapse risk. Here, we studied the ability of a recently developed model which combines clinicopathologic and gene expression variables (CP-GEP) to identify stage I/IIA melanoma patients who have a high risk for disease relapse. PATIENTS AND METHODS Archival specimens from a cohort of 837 consecutive primary CMs were used for assessing the prognostic performance of CP-GEP. The CP-GEP model combines Breslow thickness and patient age, with the expression of eight genes in the primary tumour. Our specific patient group, represented by 580 stage I/IIA patients, was stratified based on their risk of relapse: CP-GEP High Risk and CP-GEP Low Risk. The main clinical end-point of this study was five-year relapse-free survival (RFS). RESULTS Within the stage I/IIA melanoma group, CP-GEP identified a high-risk patient group (47% of total stage I/IIA patients) which had a considerably worse five-year RFS than the low-risk patient group; 74% (95% confidence interval [CI]: 67%-80%) versus 89% (95% CI: 84%-93%); hazard ratio [HR] = 2.98 (95% CI: 1.78-4.98); P < 0.0001. Of patients in the high-risk group, those who relapsed were most likely to do so within the first 3 years. CONCLUSION The CP-GEP model can be used to identify stage I/IIA patients who have a high risk for disease relapse. These patients may benefit from adjuvant therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Mark A Cappel
- Mayo Clinic, Jacksonville, FL, USA; Gulf Coast Dermatopathology Laboratory, Tampa, FL, USA
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Quattrocchi E, Sominidi-Damodaran S, Murphree DH, Meves A. β3 integrin immunohistochemistry as a method to predict sentinel lymph node status in patients with primary cutaneous melanoma. Int J Dermatol 2020; 59:1241-1248. [PMID: 32772371 DOI: 10.1111/ijd.15125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/08/2020] [Accepted: 07/15/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Integrins are heterodimeric proteins composed of noncovalently linked ɑ and β subunits which are essential for a wide range of normal physiology and also play prominent roles in cancer. Here we tested whether integrin expression in diagnostic skin biopsies is associated with sentinel lymph node (SLN) metastasis. METHODS We utilized a cohort of 854 consecutive patients with primary cutaneous melanoma to quantify the expression of β integrin subunits by reverse transcriptase quantitative PCR (RT-qPCR). In addition, we quantified the expression of β3 integrin by immunohistochemistry (IHC) in a subset of 271 patients by H score. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. Logistic regression analyses were used to develop models for the likelihood of SLN metastasis from molecular, clinical, and histologic variables. RESULTS β3 integrin expression quantified by IHC or RT-qPCR was associated with SLN metastasis. β1, β5, β6, and β8 integrin expression was not associated with SLN metastasis. The incremental gain in performance of a predictive model which included β3 integrin expression as quantified by IHC in combination with established clinicopathologic variables (Breslow depth and patient age) was limited. CONCLUSIONS β3 integrin is the principal integrin subunit associated with sentinel lymph node biopsy (SLNb) metastasis in primary cutaneous melanoma. However, β3 integrin H score does not significantly improve models for the likelihood of SLN metastasis over Breslow depth and patient age.
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Affiliation(s)
| | | | - Dennis H Murphree
- Division of Digital Health Sciences, Mayo Clinic, Rochester, MN, USA
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10
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Timing of sentinel node biopsy independently predicts disease-free and overall survival in clinical stage I-II melanoma patients: A multicentre study of the Italian Melanoma Intergroup (IMI). Eur J Cancer 2020; 137:30-39. [PMID: 32739767 PMCID: PMC7391020 DOI: 10.1016/j.ejca.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 01/20/2023]
Abstract
Background Sentinel lymph node biopsy (SNB) still remains a key procedure to appropriately stage melanoma patients and to select those who are candidate to novel treatments with immunotherapy and targeted therapy in the adjuvant setting. The impact of timing of SNB on disease-free survival (DFS) and overall survival (OS) is still unclear. Material and methods The study was conducted at 6 Italian Melanoma Intergroup (IMI) centres and included 8953 consecutive clinical stage I-II melanoma patients who were diagnosed, treated, and followed up between November 1997 and March 2018. All patients were prospectively included in dedicated IMI database. Multivariable Cox regression analyses were performed to investigate how baseline characteristics and time interval until SNB are related to DFS and OS. Results Considering the whole population, at multivariable analysis, after adjusting for age, gender, Breslow thickness, site, ulceration, and the SNB status, a delay in the timing of SNB was associated with a better DFS (adjusted hazard ratio [aHR, delayed versus early SNB] 0.98, 95% confidence interval [CI] 0.97–0.99, p < 0.001) and OS (aHR 0.98, 95% CI 0.97–0.99, p = 0.001). Specifically, in patients with a negative SNB status, a beneficial impact of delayed SNB (i.e. at least 32 days after primary excision) was confirmed for DFS (aHR 0.70, 95%CI 0.63–0.79, p < 0.001) and OS (aHR 0.69, 95%CI 0.61–0.78, p < 0.001), whereas in those with a positive SNB status, DFS (aHR 0.96, 95%CI 0.84–1.09, p = 0.534) and OS (aHR 0.94 95%CI 0.81–1.08, p = 0.374) were not significantly different in patients with early or delayed SNB. Conclusions Our study does not support a strict time interval for SNB. These results may be useful for national guidelines, for counselling patients and reducing the number of high urgency referrals.
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Verver D, Rekkas A, Garbe C, van Klaveren D, van Akkooi ACJ, Rutkowski P, Powell BWEM, Robert C, Testori A, van Leeuwen BL, van der Veldt AAM, Keilholz U, Stadler R, Eggermont AMM, Verhoef C, Leiter U, Grünhagen DJ. The EORTC-DeCOG nomogram adequately predicts outcomes of patients with sentinel node-positive melanoma without the need for completion lymph node dissection. Eur J Cancer 2020; 134:9-18. [PMID: 32454396 DOI: 10.1016/j.ejca.2020.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Based on recent advances in the management of patients with sentinel node (SN)-positive melanoma, we aimed to develop prediction models for recurrence, distant metastasis (DM) and overall mortality (OM). METHODS The derivation cohort consisted of 1080 patients with SN-positive melanoma from nine European Organization for Research and Treatment of Cancer (EORTC) centres. Prognostic factors for recurrence, DM and OM were studied with Cox regression analysis. Significant factors were incorporated in the models. Performance was assessed by discrimination (c-index) and calibration in cross-validation across centres. The models were externally validated using a prospective cohort consisting of 705 German patients with SN-positive: 473 trial participants of the German Dermatologic Cooperative Oncology Group study (DeCOG-SLT) and 232 screened patients. A nomogram was developed for graphical presentation. RESULTS The final model for recurrence and the calibrated models for DM and OM included ulceration, age, SN tumour burden and Breslow thickness. The models showed reasonable calibration. The c-index for the recurrence, DM and OM model was 0.68, 0.70 and 0.70, respectively, and 0.70, 0.72 and 0.74, respectively, in external validation. The EORTC-DeCOG model identified a robust low-risk group, with all identified low-risk patients (approximately 4% of the entire population) having a 5-year recurrence probability of <25% and an overall 5-year recurrence rate of 13%. A model including information on completion lymph node dissection (CLND) showed only marginal improvement in model performance. CONCLUSIONS The EORTC-DeCOG nomogram provides an adequate prognostic tool for patients with SN-positive melanoma, without the need for CLND. It showed consistent results across validation. The nomogram could be used for patient counselling and might aid in adjuvant therapy decision-making.
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Affiliation(s)
- Daniëlle Verver
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - A Rekkas
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Claus Garbe
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - David van Klaveren
- Department of Medical Statistics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Alexander C J van Akkooi
- Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Amsterdam, the Netherlands
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncological Center, Warsaw, Poland
| | | | - Caroline Robert
- Department of Dermatology and Allergology, Cancer Institute Gustave Roussy, Villejuif, France
| | | | - Barbara L van Leeuwen
- Department of Surgical Oncology, Groningen University, University Medical Centre Groningen, Groningen, the Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Ulrich Keilholz
- Director of the Charité Comprehensive Cancer Center, Charité - University of Medicine Berlin, Berlin, Germany
| | - Rudolf Stadler
- Department of Dermatology, University Hospital Johannes Wesling Minden, Minden, Germany
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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12
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Bellomo D, Arias-Mejias SM, Ramana C, Heim JB, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Pittelkow MR, DiCaudo DJ, Pockaj BA, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, van Vliet MH, Dwarkasing J, Meves A. Model Combining Tumor Molecular and Clinicopathologic Risk Factors Predicts Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. JCO Precis Oncol 2020; 4:319-334. [PMID: 32405608 PMCID: PMC7220172 DOI: 10.1200/po.19.00206] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE More than 80% of patients who undergo sentinel lymph node (SLN) biopsy have no nodal metastasis. Here we describe a model that combines clinicopathologic and molecular variables to identify patients with thin and intermediate thickness melanomas who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis. PATIENTS AND METHODS Genes with functional roles in melanoma metastasis were discovered by analysis of next generation sequencing data and case control studies. We then used PCR to quantify gene expression in diagnostic biopsy tissue across a prospectively designed archival cohort of 754 consecutive thin and intermediate thickness primary cutaneous melanomas. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. A penalized maximum likelihood estimation algorithm was used to train logistic regression models in a repeated cross validation scheme to predict the presence of SLN metastasis from molecular, clinical and histologic variables. RESULTS Expression of genes with roles in epithelial-to-mesenchymal transition (glia derived nexin, growth differentiation factor 15, integrin β3, interleukin 8, lysyl oxidase homolog 4, TGFβ receptor type 1 and tissue-type plasminogen activator) and melanosome function (melanoma antigen recognized by T cells 1) were associated with SLN metastasis. The predictive ability of a model that only considered clinicopathologic or gene expression variables was outperformed by a model which included molecular variables in combination with the clinicopathologic predictors Breslow thickness and patient age; AUC, 0.82; 95% CI, 0.78-0.86; SLN biopsy reduction rate of 42% at a negative predictive value of 96%. CONCLUSION A combined model including clinicopathologic and gene expression variables improved the identification of melanoma patients who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark A. Cappel
- Mayo Clinic, Jacksonville, FL
- Gulf Coast Dermatopathology Laboratory, Tampa, FL
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13
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Richtig G, Richtig E, Neiss AN, Quehenberger F, Gmainer DG, Kamolz LP, Lumenta DB. Does the time interval between sentinel lymph node biopsy and completion lymph node dissection affect outcome in malignant melanoma? A retrospective cohort study. Int J Surg 2020; 75:160-164. [PMID: 32036082 DOI: 10.1016/j.ijsu.2020.01.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/08/2020] [Accepted: 01/29/2020] [Indexed: 12/16/2022]
Abstract
Nodal clearance was recommended after positive sentinel lymph node biopsy (SLNB) despite further metastases to the regional lymph node basin being found in only 6-21% in the literature. This retrospective study was conducted to determine the role of the time interval between excision of primary melanoma and confirmed metastasis in the sentinel lymph node biopsy as well as the one between positive sentinel lymph node biopsy (SLNB-positive patients) and subsequent completion lymph node dissection (CLND) on the presence of metastases. The monocentric analysis included 121 patients with a history of completion lymph node dissection after positive SLNB from January 2005 to October 2013. Additional metastases in the regional lymph node basin (non-sentinels) were found in 14.05% (n = 17). Significant risk factors for the presence of metastases in CLND were the time between confirmed primary tumour to metastasis in sentinel lymph nodes (SLN) (p = 0.0034), N-category of TNM-classification (p = 0.0066) and independent of thickness of primary tumour (p = 0.11). If SLNB was performed up to forty-three days after confirmed primary melanoma, subsequent lymph node dissection was positive in less than 9.1%. When SLNB was performed with a delay of more than 80 days, all patients had metastases in the CLND specimens. Our data analysis suggests that delays in subsequent procedures of SLNB after diagnosis of primary melanoma may have a greater impact on positivity of non-sentinel lymph nodes than previously assumed. Our retrospective analysis may indicate the reconsideration of time schedule in the management of primary melanoma to potentially avoid local relapse in the draining lymph node region after positive SLNB.
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Affiliation(s)
- G Richtig
- Otto Loewi Research Center, Pharmacology Section, Medical University of Graz, Universitätsplatz 4, A-8010, Graz, Austria; Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
| | - E Richtig
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
| | - A N Neiss
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery Graz, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
| | - F Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, A-8036, Graz, Austria
| | - D G Gmainer
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery Graz, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
| | - L P Kamolz
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery Graz, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
| | - D B Lumenta
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery Graz, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
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14
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Risk stratification of sentinel node–positive melanoma patients defines surgical management and adjuvant therapy treatment considerations. Eur J Cancer 2018; 96:25-33. [DOI: 10.1016/j.ejca.2018.02.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 12/19/2022]
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15
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Wouters MW, Michielin O, Bastiaannet E, Beishon M, Catalano O, Del Marmol V, Delgado-Bolton R, Dendale R, Trill MD, Ferrari A, Forsea AM, Kreckel H, Lövey J, Luyten G, Massi D, Mohr P, Oberst S, Pereira P, Prata JPP, Rutkowski P, Saarto T, Sheth S, Spurrier-Bernard G, Vuoristo MS, Costa A, Naredi P. ECCO essential requirements for quality cancer care: Melanoma. Crit Rev Oncol Hematol 2018; 122:164-178. [PMID: 29458785 DOI: 10.1016/j.critrevonc.2017.12.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND ECCO essential requirements for quality cancer care (ERQCC) are explanations and descriptions of challenges, organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. MELANOMA ESSENTIAL REQUIREMENTS FOR QUALITY CARE: CONCLUSION: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for melanoma. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams and specialised treatments is guaranteed to all patients with melanoma.
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Affiliation(s)
- Michel W Wouters
- European Society of Surgical Oncology (ESSO); Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olivier Michielin
- European Society for Medical Oncology (ESMO); Department of Oncology, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Esther Bastiaannet
- International Society of Geriatric Oncology (SIOG); Department of Surgery/Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Orlando Catalano
- European Society of Radiology (ESR); Department of Radiology, National Cancer Institute Fondazione Pascale, Naples, Italy
| | - Veronique Del Marmol
- Association of European Cancer Leagues (ECL); Euromelanoma, European Academy of Dermatology and Venereology (EADV); Department of Dermatology and Venereology, Erasme Hospital, ULB, Brussels, Belgium
| | - Roberto Delgado-Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Rémi Dendale
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Institut Curie, Paris, France
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Andrea Ferrari
- European Society for Paediatric Oncology (SIOPE); Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ana-Maria Forsea
- European Association of Dermato Oncology (EADO); Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Hannelore Kreckel
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, University Hospital Giessen and Marburg, Giessen, Germany
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Gre Luyten
- Ocular Oncology Group (OOG); Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniela Massi
- European Society of Pathology (ESP); Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Mohr
- European Society of Skin Cancer Prevention (EUROSKIN); Elbe-Klinikum Buxtehude, Buxtehude, Germany
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cambridge Cancer Centre, Cambridge, UK
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Clinics Heilbronn, Karl-Ruprecht-University of Heidelberg, Heilbronn, Germany
| | - João Paulo Paiva Prata
- European Oncology Nursing Society (EONS); Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Piotr Rutkowski
- European Organisation for Research and Treatment of Cancer (EORTC); Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Comprehensive Cancer Center, Department of Palliative Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sapna Sheth
- European CanCer Organisation, Brussels, Belgium
| | - Gilly Spurrier-Bernard
- European CanCer Organisation (ECCO) Patient Advisory Committee; Melanoma Patient Network Europe; Paris, France
| | - Meri-Sisko Vuoristo
- Association of European Cancer Leagues (ECL); Pirkanmaa Cancer Society, Tampere, Finland
| | | | - Peter Naredi
- European CanCer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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16
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Nelson DW, Stern S, Elashoff DE, Elashoff R, Thompson JF, Mozzillo N, Nieweg OE, Hoekstra HJ, Cochran AJ, Faries MB. Impact of Time Between Diagnosis and SLNB on Outcomes in Cutaneous Melanoma. J Am Coll Surg 2017; 225:302-311. [PMID: 28668274 DOI: 10.1016/j.jamcollsurg.2017.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hypothetically, delay between melanoma diagnosis and SLNB could affect outcomes, either adversely by allowing growth and dissemination of metastases, or beneficially by allowing development of an anti-melanoma immune response. Available data are conflicting about the effect of SLNB delay on patient survival. Our objective was to determine whether delay between initial diagnosis and SLNB affects outcomes in patients with cutaneous melanoma. STUDY DESIGN We performed query and analysis of a large prospectively maintained database of patients with primary cutaneous melanomas undergoing SLNB. An independent dataset from MSLT-1 (Multicenter Selective Lymphadenectomy Trial-1) was used for validation. Primary outcomes included disease-free survival and melanoma-specific survival. RESULTS Early and delayed SLNB were defined as less than 30 and 30 or more days from initial diagnosis, respectively. There were 2,483 patients that met inclusion criteria. Positive sentinel lymph nodes were identified in 17.4% (n = 432). Among all patients, 42% had SLNB 30 or more days after diagnosis and 37% of positive sentinel lymph nodes were at 30 or more days. No differences in sex, anatomic site, or histopathologic features were identified between the 2 groups. There was no difference in melanoma-specific survival or disease-free survival between those undergoing early or delayed SLNB. Examination of MSLT-1 trial data similarly demonstrated no difference in survival outcomes. CONCLUSIONS This, the largest study on this subject to date, found no adverse impact on long-term clinical outcomes of patients due to delay of SLNB beyond 30 days. The MSLT-1 data confirm this result. Patients can be reassured that if the operation is performed 30 or more days after diagnosis, it will not cause harm.
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Affiliation(s)
- Daniel W Nelson
- Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA
| | - Stacey Stern
- Department of Biostatistics, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA
| | - David E Elashoff
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA
| | - Robert Elashoff
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Harald J Hoekstra
- Division of Surgical Oncology, Groningen University, University Medical Center Groningen, Groningen, The Netherlands
| | - Alistair J Cochran
- Department of Pathology, University of California Los Angeles, Los Angeles, CA
| | - Mark B Faries
- Division of Surgical Oncology, The Angeles Clinic and Research Institute, Los Angeles, CA.
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17
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Oude Ophuis CMC, van Akkooi ACJ, Rutkowski P, Powell WEM, Robert C, Testori A, van Leeuwen BL, Siegel P, Eggermont AMM, Verhoef C, Grünhagen DJ. Timing of completion lymphadenectomy after positive sentinel node biopsy in patients with melanoma. Br J Surg 2017; 104:726-733. [DOI: 10.1002/bjs.10475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/30/2016] [Accepted: 12/02/2016] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Nodal staging with sentinel node biopsy (SNB) and completion lymph node dissection (CLND) provides prognostic information to patients with melanoma and their physicians. It is not known whether the timing of CLND is associated with survival outcome and/or CLND tumour load. This study investigated whether CLND timing is associated with CLND tumour load, disease-free survival (DFS) and/or melanoma-specific survival (MSS).
Methods
A retrospective cohort of patients with SNB-positive melanoma from nine European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group centres undergoing surgery between 1993 and 2009 were examined. Patients were selected based on availability of CLND and follow-up data. The CLND interval was defined as the number of days between diagnosis and CLND. Patient and tumour characteristics were collected. Five-year DFS and MSS rates were calculated. Cox and logistic regression analysis were performed, adjusting for known prognostic/predictive indicators.
Results
A total of 784 patients were included in the study. Their median age was 51 (i.q.r. 40–62) years, and 418 patients (53·3 per cent) were men. Median Breslow thickness was 3·0 (i.q.r. 2·0–5·0) mm, and 148 patients (18·9 per cent) had a residual tumour load. Median CLND interval was 84 (i.q.r. 65–105) days. Five-year DFS and MSS rates were not significantly different for patients operated on with a median CLND interval of less than 84 days and those with an interval of at least 84 days (DFS: 54·2 versus 53·3 per cent respectively; MSS: 66·9 versus 65·1 per cent). In a multivariable Cox model, CLND interval was not a significant prognostic indicator. CLND interval was negatively correlated with identification of positive non-sentinel nodes, but following adjustment for known risk factors this effect was no longer found.
Conclusion
The time interval between diagnosis of melanoma and CLND did not influence CLND tumour load, DFS or MSS.
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Affiliation(s)
- C M C Oude Ophuis
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A C J van Akkooi
- Department of Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - W E M Powell
- Melanoma Unit, St George's Foundation University Hospital, London, UK
| | - C Robert
- Department of Dermatology and Allergology, Cancer Institute Gustave Roussy, Villejuif, France
| | - A Testori
- Division of Dermato-Oncological Surgery, European Institute of Oncology, Milan, Italy
| | - B L van Leeuwen
- Department of Surgical Oncology, Groningen University, University Medical Centre Groningen, Groningen, The Netherlands
| | - P Siegel
- Department of Dermatology and Allergology, Charité – University of Medicine Berlin, Berlin, Germany
| | - A M M Eggermont
- Board of Directors, Cancer Institute Gustave Roussy, Villejuif, France
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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18
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Tejera-Vaquerizo A, Nagore E. Effect of time to sentinel lymph node biopsy on cutaneous melanoma survival: a matter of discussion. Am J Surg 2017; 213:204-205. [DOI: 10.1016/j.amjsurg.2016.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
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19
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Oude Ophuis CM, van Akkooi AC, Rutkowski P, Voit CA, Stepniak J, Erler NS, Eggermont AM, Wouters MW, Grünhagen DJ, Verhoef C(K. Effects of time interval between primary melanoma excision and sentinel node biopsy on positivity rate and survival. Eur J Cancer 2016; 67:164-173. [DOI: 10.1016/j.ejca.2016.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/15/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
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