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Shemer M, Shimonovitz M, Furer R, Abu-Abeid A, Dayan D, Schneebaum S, Miodovnik M, Nizri E. Long-term outcomes and patterns of recurrence in patients with thin melanoma and a negative sentinel lymph node biopsy: a single-center experience. Melanoma Res 2024:00008390-990000000-00156. [PMID: 38874499 DOI: 10.1097/cmr.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The majority of patients diagnosed with melanoma have thin melanomas (≤1 mm). Data on the rate and pattern of recurrence after a negative sentinel lymph node biopsy (SLNB) are sparse. We retrospectively searched our institutional database and retrieved the records of patients with thin melanomas who underwent an SLNB with negative results. We analyzed patterns of recurrence, time to recurrence, and mode of diagnosis. Thirteen of the 198 patients with thin melanomas and negative SLNB results had tumor recurrence (6.5%): two local in transit (15.4%), three regional (21.3%), and eight distant (61.5%). Distant recurrences tended to occur later than local or regional ones [median disease-free survival = 50 months (95% confidence interval: 36.1-63.9) vs. 34 and 15 months (95% confidence interval: 5.4-24.6), P = 0.005, respectively]. The percentage of patients with tumor thickness ≥0.8 mm was higher among those who sustained recurrence (84.6 vs. 64.9% for no recurrence, P = 0.04). The majority of patients with recurrence were not being followed up when diagnosed (69%), and they are presented because of clinical symptoms. Patients with recurrence had lower survival compared with those without recurrence (median: 118 months vs. ongoing survival, P < 0.001, respectively). Melanoma recurrence in patients with thin melanomas and negative SLNBs is rare, tends to be distant, and negatively affects prognosis. Recurrence tends to occur in patients with melanoma thickness ≥0.8 mm. Further studies are needed to identify patients with high recurrence risk and determine optimal follow-up protocols.
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Affiliation(s)
- Maayan Shemer
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Shimonovitz
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rozalin Furer
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
| | - Danit Dayan
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
| | - Schlomo Schneebaum
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mor Miodovnik
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eran Nizri
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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2
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Coit DG, Ariyan CE. Fifty years of progress in surgical oncology: Melanoma. J Surg Oncol 2022; 126:888-895. [PMID: 36087090 PMCID: PMC9473298 DOI: 10.1002/jso.27081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022]
Abstract
This paper outlines the scientific and clinical advances in the treatment of melanoma over the past 50 years. Among the highlights of progress, the dominant themes include evidence-based reduction in the extent and morbidity of surgical procedures in patients with local or regional melanoma without compromising end results, and the introduction of effective systemic therapy, specifically targeted therapy matched to patients based on specific tumor mutations, and immune checkpoint blockade. Management of advanced disease has also changed dramatically, due to improved understanding of the genomic variability of the disease as well as continuing improvements in imaging.
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Affiliation(s)
- Daniel G Coit
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Charlotte E Ariyan
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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3
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Angeramo CA, Laxague F, Armella ED, Rodríguez Catán J, Vigovich FA, Mezzadri NA, Fernandez Vila JM. Tumor-Infiltrating Lymphocytes in Patients with Melanoma: Which Is Its Prognostic Value? Indian J Surg Oncol 2021; 12:770-775. [DOI: 10.1007/s13193-021-01427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
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4
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Wang L, Wu J, Dai Z, Ji S, Jiang R. Clinical characteristics and prognosis of acral lentiginous melanoma: a single-center series of 211 cases in China. Int J Dermatol 2021; 60:1504-1509. [PMID: 34145578 DOI: 10.1111/ijd.15642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/19/2021] [Accepted: 04/09/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is common in China with poor prognosis. However, there are only a few studies of ALM in the Asian population. We aimed to summarize and analyze the clinical characteristics, treatment strategy, treatment effect, and prognostic factors of ALM in a Chinese population. METHODS We included a total of 249 ALM patients (211 with follow-up data) from a single institution. Demographic, laboratory data, treatment strategy, and prognosis were analyzed. RESULTS The ratio of male and female was 1.3 ∶ 1.0. The median age was 58 years old. The majority of patients (70.3%) had lesions on the sole. Trauma history and irritation were associated with lesion size increase in some patients. The prognosis of patients in stage II-III undergoing standard operation was significantly better compared with those without surgical treatment. Patients who did not receive postoperative adjuvant treatment had shorter time to distant metastasis. In multivariable analysis, distant metastasis, duration of disease, LDH level, and Ki67 index were independently associated with survival. CONCLUSIONS Prognosis for ALM patients was poor in our study. Distant metastasis, duration of disease, LDH level, and Ki67 index were independently associated with prognosis.
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Affiliation(s)
- Lei Wang
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Junshen Wu
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhibing Dai
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Suzhi Ji
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Renbing Jiang
- Department of Bone and Soft Tissue, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
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5
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Kocsis A, Karsko L, Kurgyis Z, Besenyi Z, Pavics L, Dosa-Racz E, Kis E, Baltas E, Ocsai H, Varga E, Bende B, Varga A, Mohos G, Korom I, Varga J, Kemeny L, Nemeth IB, Olah J. Is it Necessary to Perform Sentinel Lymph Node Biopsy in Thin Melanoma? A Retrospective Single Center Analysis. Pathol Oncol Res 2020; 26:1861-1868. [PMID: 31792874 PMCID: PMC7297827 DOI: 10.1007/s12253-019-00769-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/21/2019] [Indexed: 01/09/2023]
Abstract
Sentinel lymph node biopsy (SLNB) is a standard procedure for regional lymph node staging and still has the most important prognostic value for the outcome of patients with thin melanoma. In addition to ulceration, SLNB had to be considered even for a single mitotic figure in thin (<1 mm) melanoma according to AJCC7th guideline, therefore, a retrospective review was conducted involving 403 pT1 melanoma patients. Among them, 152 patients suffered from pT1b ulcerated or mitotic rate ≥ 1/ mm2 melanomas according to the AJCC7th staging system. SLNB was performed in 78 cases, of which nine (11.5%) showed SLN positivity. From them, interestingly, we found a relatively high positive sentinel rate (6/78-8%) in the case of thin primary melanomas ˂0.8 mm. Moreover, the presence of regression increased the probability of sentinel positivity by 5.796 fold. After reassessing pT stage based on the new AJCC8th, 37 pT1b cases were reordered into pT1a category. There was no significant relation between other characteristics examined (age, gender, Breslow, Clark level, and mitosis index) and sentinel node positivity. Based on our data, we suggest that mitotic rate alone is not a sufficiently powerful predictor of SLN status in thin melanomas. If strict histopathological definition criteria are applied, regression might be an additional adverse feature that aids in identifying T1 patients most likely to be SLN-positive. After reassessing of pT1b cases according to AJCC8th regression proved to be independent prognostic factor on sentinel lymph node positivity. Our results propose that sentinel lymph node biopsy might also be considered at patients with regressive thin (˂0.8 mm) melanomas.
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Affiliation(s)
- A Kocsis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - L Karsko
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Zs Kurgyis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Zs Besenyi
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - L Pavics
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - E Dosa-Racz
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - E Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - E Baltas
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - H Ocsai
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - E Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - B Bende
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - A Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - G Mohos
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - I Korom
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - J Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - L Kemeny
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - I B Nemeth
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
| | - J Olah
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
- Department of Oncology, Faculty of General Medicine, University of Szeged, Szeged, Hungary
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6
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Hu Y, Briggs A, Gennarelli RL, Bartlett EK, Ariyan CE, Coit DG, Brady MS. Sentinel Lymph Node Biopsy for T1b Melanoma: Balancing Prognostic Value and Cost. Ann Surg Oncol 2020; 27:5248-5256. [PMID: 32514805 DOI: 10.1245/s10434-020-08558-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this study is to report the additional prognostic information and cost associated with sentinel lymph node biopsy (SLNB) for patients with T1b melanoma. PATIENTS AND METHODS An institutional database was queried for patients with T1b melanoma (0.8-1.0 mm or < 0.8 mm with ulceration) with at least 5 years of follow-up. Results of SLNB, completion lymphadenectomy (CLND), recurrence, and melanoma-specific survival (MSS) were assessed. Institutional costs of melanoma care were converted to Medicare proportional dollars. A Markov model was created to estimate long-term costs. RESULTS Among the total 392 patients, 238 underwent SLNB. Median follow-up was 10.5 years. SLNB was positive in 19 patients (8.0%). Patients who underwent SLNB had higher 10-year nodal recurrence-free survival (98.6% vs. 91.2%, p < 0.001) but not MSS (94.4% vs. 93.2%, p = 0.55). Ulceration (HR 4.7, p = 0.022) and positive sentinel node (HR 11.5, p < 0.001) were associated with worse MSS. Estimates for 5-year costs reflect a fourfold increase in total costs of care associated with SLNB. However, a treatment plan that forgoes adjuvant therapy for resected stage IIIA melanoma but offers systemic therapy for a node-basin recurrence would nullify the additional cost of SLNB. CONCLUSIONS SLNB is prognostic for T1b melanoma. Its impact on the overall cost of melanoma care is intimately tied to systemic therapy in the adjuvant and recurrent settings.
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Affiliation(s)
- Yinin Hu
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Briggs
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renee L Gennarelli
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edmund K Bartlett
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charlotte E Ariyan
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary S Brady
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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7
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Isom C, Wheless L, Hooks MA, Kauffmann RM. Early Melanoma Nodal Positivity and Biopsy Rates Before and After Implementation of the 7th Edition of the AJCC Cancer Staging Manual. JAMA Dermatol 2020; 155:572-577. [PMID: 30840034 DOI: 10.1001/jamadermatol.2018.5902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance There has been a continued increase in the incidence of newly diagnosed melanomas, most of which are T1 melanomas. The associations between changes in tumor staging, implemented with the 7th edition of the AJCC Cancer Staging Manual (AJCC 7), and sentinel lymph node biopsy rates and nodal positivity rates remain to be seen. Objective To evaluate the change that the implementation of the AJCC 7 had on staging criteria and the distribution of thin melanomas requiring nodal surgery and nodal positivity rates. Design, Setting, and Participants Retrospective cross-sectional study from 2004 through 2013 of all adults (≥18 years) diagnosed with a T1 (Breslow depth ≤1.0 mm) melanoma using The National Cancer Database that captures 70% of all newly diagnosed cancers from accredited Commission on Cancer organizations, including both academic and community settings. Data were analyzed in May 2017. Exposures Patients were grouped together based on year of diagnosis, before and after 2009. Main Outcomes and Measures To determine the sentinel lymph node biopsy rate before and after the implementation of the AJCC 7. Results A total of 141 280 patients met inclusion criteria. Of 86 846 patients diagnosed from 2004 through 2009, 53.7% (49 644) were male and had a mean (SD) age of 57.7 (16.4) years. Of 54 434 patients diagnosed from 2010 through 2013, 54.3% (31 086) were male and had a mean (SD) age of 59.5 (15.9) years. After 2010, there was a 3.8% decrease in the number of nodal surgeries performed (32 485 of 86 846 patients [37.6%] vs 18 379 of 54 434 patients [33.8%]; P < .001). The nodal positivity rate decreased 1.0% from (9.8% [3166 of 86 846] to 8.8% [1618 of 54 434]) (P < .001). An increase in the proportion of T1b melanomas being evaluated, from 48.8% to 62.2%, was seen (P < .001). Of T1b melanomas that underwent nodal evaluation from 2004 through 2009, 74.0% had Clark level IV (invasion of the reticular dermis) or Clark level V (invasion of the deep, subcutaneous tissue) and 9.5% were ulcerated. From 2010 through 2013, of the T1b melanomas undergoing nodal evaluation, 82.6% had an elevated mitotic rate only, 3.7% were ulcerated, and 13.7% had both ulceration and an elevated mitotic rate. Conclusions and Relevance It appears that after the institution of AJCC 7, there was an overall decrease in the number of T1 melanomas undergoing nodal biopsy without a clinically relevant change in sentinel lymph node positivity, with an increase in the number of T1b melanomas undergoing nodal evaluation.
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Affiliation(s)
- Chelsea Isom
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary A Hooks
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rondi M Kauffmann
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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8
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Friedman C, Lyon M, Torphy RJ, Thieu D, Hosokawa P, Gonzalez R, Lewis KD, Medina TM, Rioth MJ, Robinson WA, Kounalakis N, McCarter MD, Gleisner AL. A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making. J Surg Oncol 2019; 120:1276-1283. [PMID: 31602665 DOI: 10.1002/jso.25720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/19/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop a nomogram to estimate the probability of positive sentinel lymph node (+SLN) for patients with thin melanoma and to characterize its potential impact on sentinel lymph node biopsy (SLNB) rates. METHODS Patients diagnosed with thin (0.5-1.0 mm) melanoma were identified from the National Cancer Database 2012 to 2015. A multivariable logistic regression model was used to examine factors associated with +SLN, and a nomogram to predict +SLN was constructed. Nomogram performance was evaluated and diagnostic test statistics were calculated. RESULTS Of the 21 971 patients included 10 108 (46.0%) underwent SLNB, with a 4.0% +SLN rate. On multivariable analysis, age, Breslow thickness, lymphovascular invasion, ulceration, and Clark level were significantly associated with SLN status. The area under the receiver operating curve was 0.67 (95% confidence interval, 0.65-0.70). While 15 249 (69.4%) patients had either T1b tumors or T1a tumors with at least one adverse feature, only 2846 (13.0%) had a nomogram predicted probability of a +SLN ≥5%. Using this cut-off, the indication for a SLNB in these patients would be reduced by 81.3% as compared to the American Joint Committee on Cancer 8th edition staging criteria. CONCLUSIONS The risk predictions obtained from the nomogram allow for more accurate selection of patients who could benefit from SLNB.
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Affiliation(s)
- Chloe Friedman
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Madison Lyon
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Robert J Torphy
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Daniel Thieu
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Patrick Hosokawa
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Rene Gonzalez
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Karl D Lewis
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Theresa M Medina
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Matthew J Rioth
- Department of Medicine, University of Colorado, Aurora, Colorado
| | | | | | | | - Ana L Gleisner
- Department of Surgery, University of Colorado, Aurora, Colorado
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9
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Tejera‐Vaquerizo A, Ribero S, Puig S, Boada A, Paradela S, Moreno‐Ramírez D, Cañueto J, de Unamuno B, Brinca A, Descalzo‐Gallego MA, Osella‐Abate S, Cassoni P, Carrera C, Vidal‐Sicart S, Bennássar A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández‐Orland A, Jaka A, Fernández‐Figueres MT, Hilari JM, Giménez‐Xavier P, Vieira R, Botella‐Estrada R, Román‐Curto C, Ferrándiz L, Iglesias‐Pena N, Ferrándiz C, Malvehy J, Quaglino P, Nagore E. Survival analysis and sentinel lymph node status in thin cutaneous melanoma: A multicenter observational study. Cancer Med 2019; 8:4235-4244. [PMID: 31215168 PMCID: PMC6675713 DOI: 10.1002/cam4.2358] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 12/27/2022] Open
Abstract
Mitotic rate is no longer considered a staging criterion for thin melanoma in the 8th edition of the American Joint Committee on Cancer Staging Manual. The aim of this observational study was to identify prognostic factors for thin melanoma and predictors and prognostic significance of sentinel lymph node (SLN) involvement in a large multicenter cohort of patients with melanoma from nine tertiary care hospitals. A total of 4249 consecutive patients with thin melanoma diagnosed from January 1, 1998 to December 31, 2016 were included. The main outcomes were disease-free interval and melanoma-specific survival for the overall population and predictors of SLN metastasis (n = 1083). Associations between survival and SLN status and different clinical and pathologic variables (sex, age, tumor location, mitosis, ulceration, regression, lymphovascular invasion, histologic subtype, Clark level, and Breslow thickness) were analyzed by Cox proportional hazards regression and logistic regression. SLN status was the most important prognostic factor for melanoma-specific survival (hazard ratio, 13.8; 95% CI, 6.1-31.2; P < 0.001), followed by sex, ulceration, and Clark level for patients who underwent SLNB. A mitotic rate of >2 mitoses/mm2 was the only factor associated with a positive SLN biopsy (odds ratio, 2.9; 95% CI, 1.22-7; P = 0.01. SLN status is the most important prognostic factor in thin melanoma. A high mitotic rate is associated with metastatic SLN involvement. SLN biopsy should be discussed and recommended in patients with thin melanoma and a high mitotic rate.
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Affiliation(s)
| | - Simone Ribero
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Aram Boada
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Sabela Paradela
- Departamento de DermatologíaHospital Universitario de la CoruñaLa CoruñaSpain
| | - David Moreno‐Ramírez
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Javier Cañueto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Blanca de Unamuno
- Departamento de DermatologíaHospital Universitario La FeValenciaSpain
| | - Ana Brinca
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Simona Osella‐Abate
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Paola Cassoni
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Sergi Vidal‐Sicart
- Nuclear Medicine DepartmentHospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Antoni Bennássar
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Ramón Rull
- Surgery DepartmentHospital ClinicBarcelonaSpain
| | - Llucìa Alos
- Pathology Department, Hospital ClinicUniversidad de BarcelonaBarcelonaSpain
| | - Celia Requena
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Isidro Bolumar
- Surgery DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Víctor Traves
- Pathology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Ángel Pla
- Otorhinolaringology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - A. Fernández‐Orland
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Ane Jaka
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | | | - Josep M. Hilari
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Pol Giménez‐Xavier
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Ricardo Vieira
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Concepción Román‐Curto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Lara Ferrándiz
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | | | - Carlos Ferrándiz
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Pietro Quaglino
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Eduardo Nagore
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
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Manninen AA, Gardberg M, Juteau S, Ilmonen S, Jukonen J, Andersson N, Carpén O. BRAF immunohistochemistry predicts sentinel lymph node involvement in intermediate thickness melanomas. PLoS One 2019; 14:e0216043. [PMID: 31039200 PMCID: PMC6490950 DOI: 10.1371/journal.pone.0216043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/12/2019] [Indexed: 12/31/2022] Open
Abstract
Background Sentinel node biopsy (SNB) is an important step in melanoma staging and prognostication. It is commonly performed for patients with intermediate thickness melanomas, based on clinicopathological features. However, only 20–25% of patients eventually demonstrate nodal involvement. The aim of this study was to evaluate whether tissue biomarkers with links to melanoma biology, together with clinicopathological parameters, could aid in the prediction of sentinel node involvement and improve selection of patients for SNB. In addition, we examined the role of these clinical or biological markers in disease outcome. Methods We collected a case-control cohort of 140 intermediate thickness (Breslow 0,9–4,0mm) melanoma patients with or without SNB involvement matched for age, gender, Breslow thickness and location. From this cohort, we tested the predictive value of common clinicopathological parameters (ulceration, mitotic count and tumor regression) and FMNL-2, ezrin and BRAF V600E immunoreactivity, for sentinel node involvement and survival. We further analyzed the correlations in the superficial spreading melanoma subtype. Results Based on our case control analysis, of the markers, BRAF V600E status (p = 0.010) and mitotic count (p = 0.036) correlated with SNB involvement. SNB status was a strong independent prognosticator for recurrence free survival (RFS p<0.001), melanoma specific survival (MSS p = 0.000) and overall survival (OS p = 0.029). In the superficially spreading melanoma subgroup, BRAF V600E positivity indicated poorer RFS (p = 0.039) and OS (p = 0.012). By combining the Breslow thickness, mitotic count and BRAF immunohistochemistry, we identified a group of superficially spreading melanomas with an excellent survival probability independent of SNB status. Conclusions These results demonstrate that BRAF immunohistochemistry could serve as a useful addition to a marker panel for selecting intermediate thickness melanoma patients for SNB.
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Affiliation(s)
- Atte A. Manninen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maria Gardberg
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, University of Turku and Turku University Hospital, Turku, Finland
| | - Susanna Juteau
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi Ilmonen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joonas Jukonen
- Institute of Biomedicine, University of Helsinki, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Noora Andersson
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Carpén
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- * E-mail:
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11
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Conic RRZ, Ko J, Damiani G, Funchain P, Knackstedt T, Vij A, Vidimos A, Gastman BR. Predictors of sentinel lymph node positivity in thin melanoma using the National Cancer Database. J Am Acad Dermatol 2019; 80:441-447. [PMID: 30240775 DOI: 10.1016/j.jaad.2018.08.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) specimens are often obtained from patients for further staging after these patients have undergone melanoma excision. Limited data regarding predictors of SLNB positivity in thin melanoma are available. OBJECTIVE We sought to evaluate predictors of SLNB positivity in thin melanoma. METHODS Patients with cutaneous melanoma with a Breslow thickness ≤1.00 mm who received a SLNB were identified from the National Cancer Database between 2004 and 2014 (n = 9186). Predictors of SLNB positivity were analyzed using logistic regression. RESULTS In a multivariate analysis, patients <60 years of age (P < .001) and Breslow thickness >0.8 mm (P = .03) were at increased risk for positive sentinel lymph node (SLN). Moreover, on multivariate analysis, the presence of dermal mitoses increased the odds of SLN positivity by 95% (odds ratio [OR] 1.95 [95% confidence interval {CI} 1.53-2.5], P < .001), ulceration by 63% (OR 1.63 [95% CI 1.21-2.18], P < .001), and Clark level IV to V by 48% (OR 1.48 [95% CI 1.19-1.85]). Patients without ulceration but with dermal mitoses had 92% (OR 1.92 [95% CI 1.5-2.48], P < .001) increased SLN positivity. LIMITATIONS Limited survival data are available. CONCLUSIONS Younger age, a Breslow thickness >0.8 mm, the presence of dermal mitoses, ulceration, and Clark level IV to V are positive predictors of positive SLN. While the new American Joint Committee on Cancer system has removed dermal mitotic rate from staging, continued evaluation of dermal mitotic rate could be valuable for guiding surgical decision making about SLNB.
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Affiliation(s)
- Rosalynn R Z Conic
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Giovanni Damiani
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Pauline Funchain
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Knackstedt
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alok Vij
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Allison Vidimos
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian R Gastman
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
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12
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dos Santos FDM, da Silva FC, Pedron J, Furian RD, Fortes C, Bonamigo RR. Association between tumor-infiltrating lymphocytes and sentinel lymph node positivity in thin melanoma. An Bras Dermatol 2019; 94:47-51. [PMID: 30726463 PMCID: PMC6360962 DOI: 10.1590/abd1806-4841.20197414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/13/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy in thin invasive primary cutaneous melanoma (up to 1mm thick) is a controversial subject. The presence of tumor-infiltrating lymphocytes could be a factor to be considered in the decision to perform this procedure. OBJECTIVE To evaluate the association between the presence of tumor-infiltrating lymphocytes and lymph node metastases caused by thin primary cutaneous melanoma. METHODS Cross-sectional study with 137 records of thin invasive primary cutaneous melanoma submitted to sentinel lymph node biopsy from 2003 to 2015. The clinical variables considered were age, sex and topography of the lesion. The histopathological variables assessed were: tumor-infiltrating lymphocytes, melanoma subtype, Breslow thickness, Clark levels, number of mitoses per mm2, ulceration, regression and satellitosis. Univariate analyzes and logistic regression tests were performed as well the odds ratio and statistical relevance was considered when p <0.05. RESULTS Among the 137 cases of thin primary cutaneous melanoma submitted to sentinel lymph node biopsy, 10 (7.3%) had metastatic involvement. Ulceration on histopathology was positively associated with the presence of metastatic lymph node, with odds ratio =12.8 (2.77-59.4 95% CI, p=0.001). The presence of moderate/marked tumor-infiltrating lymphocytes was shown to be a protective factor for the presence of metastatic lymph node, with OR=0.20 (0.05-0.72 95% CI, p=0.014). The other variables - clinical and histopathological - were not associated with the outcome. STUDY LIMITATIONS The relatively small number of positive sentinel lymph node biopsy may explain such an expressive association of ulceration with metastatization. CONCLUSIONS In patients with thin invasive primary cutaneous melanoma, few or absent tumor-infiltrating lymphocytes, as well as ulceration, represent independent risk factors for lymph node metastasis.
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Affiliation(s)
| | - Felipe Correa da Silva
- Discipline of Pathology, Faculdade de Medicina da Universidade
Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS),
Brazil
| | - Julia Pedron
- Discipline of Pathology, Faculdade de Medicina da Universidade
Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS),
Brazil
| | | | - Cristina Fortes
- Department of Epidemiology, Istituto Dermopatico dell’Immacolata,
Rome, Italy
| | - Renan Rangel Bonamigo
- Service of Dermatology, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS), Brazil
- Pathology Post-Graduate Program, Universidade Federal de
Ciências da Saúde de Porto Alegre, Porto Alegre (RS), Brazil
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13
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Vertical Growth Phase as a Prognostic Factor for Sentinel Lymph Node Positivity in Thin Melanomas: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2018; 141:1529-1540. [PMID: 29579032 DOI: 10.1097/prs.0000000000004395] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The 2010 American Joint Committee on Cancer guidelines recommended consideration of sentinel lymph node biopsy for thin melanoma (Breslow thickness <1.0 mm) with aggressive pathologic features such as ulceration and/or high mitotic rate. The therapeutic benefit of biopsy-based treatment remains controversial. The authors conducted a meta-analysis to estimate the risk and outcomes of sentinel lymph node positivity in thin melanoma, and examined established and potential novel predictors of positivity. METHODS Three databases were searched by two independent reviewers for sentinel lymph node positivity in patients with thin melanoma. Study heterogeneity, publication bias, and quality were assessed. Data collected included age, sex, Breslow thickness, mitotic rate, ulceration, regression, Clark level, tumor-infiltrating lymphocytes, and vertical growth phase. Positivity was estimated using a random effects model. Association of positivity and clinicopathologic features was investigated using meta-regression. RESULTS Ninety-three studies were identified representing 35,276 patients with thin melanoma who underwent sentinel lymph node biopsy. Of these patients, 952 had a positive sentinel lymph node biopsy, for an event rate of 5.1 percent (95 percent CI, 4.1 to 6.3 percent). Significant associations were identified between positivity and Breslow thickness greater than 0.75 mm but less than 1.0 mm, mitotic rate, ulceration, and Clark level greater than IV. Seven studies reported on vertical growth phase, which was strongly associated with positivity (OR, 4.3; 95 percent CI, 2.5 to 7.7). CONCLUSIONS To date, this is the largest meta-analysis to examine predictors of sentinel lymph node biopsy positivity in patients with thin melanoma. Vertical growth phase had a strong association with biopsy positivity, providing support for its inclusion in standardized pathologic reporting.
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14
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Isaksson K, Nielsen K, Mikiver R, Nieweg OE, Scolyer RA, Thompson JF, Ingvar C. Sentinel lymph node biopsy in patients with thin melanomas: Frequency and predictors of metastasis based on analysis of two large international cohorts. J Surg Oncol 2018; 118:599-605. [DOI: 10.1002/jso.25208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/26/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Karolin Isaksson
- Department of Clinical Sciences Lund, Surgery; Lund University, Skåne University Hospital; Lund Sweden
| | - Kari Nielsen
- Department of Clinical Sciences Lund, Dermatology; Lund University, Helsingborg Hospital; Helsingborg Sweden
| | - Rasmus Mikiver
- Department of Clinical and Experimental Medicine; Regional Cancer Center South East Sweden, Linköping University; Linköping Sweden
| | - Omgo E. Nieweg
- Melanoma Institute Australia, The University of Sydney; Sydney New South Wales Australia
- Sydney Medical School, The University of Sydney; Sydney New South Wales Australia
- Departments of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Richard A. Scolyer
- Melanoma Institute Australia, The University of Sydney; Sydney New South Wales Australia
- Sydney Medical School, The University of Sydney; Sydney New South Wales Australia
- Departments of Tissue Pathology and Diagnostic Oncolocy, Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - John F. Thompson
- Melanoma Institute Australia, The University of Sydney; Sydney New South Wales Australia
- Sydney Medical School, The University of Sydney; Sydney New South Wales Australia
- Departments of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Christian Ingvar
- Department of Clinical Sciences Lund, Surgery; Lund University, Skåne University Hospital; Lund Sweden
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15
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Stiegel E, Xiong D, Ya J, Funchain P, Isakov R, Gastman B, Vij A. Prognostic value of sentinel lymph node biopsy according to Breslow thickness for cutaneous melanoma. J Am Acad Dermatol 2018; 78:942-948. [DOI: 10.1016/j.jaad.2018.01.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/27/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
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16
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Tagliabue L, Vassallo S, Malaspina S, Luciani A. Imaging melanoma: when and why. A proposal for a modern approach. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Mitotic rate is associated with positive lymph nodes in patients with thin melanomas. J Am Acad Dermatol 2017; 78:935-941. [PMID: 29198779 DOI: 10.1016/j.jaad.2017.11.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The American Joint Commission on Cancer will remove mitotic rate from its staging guidelines in 2018. OBJECTIVE Using a large nationally representative cohort, we examined the association between mitotic rate and lymph node positivity among thin melanomas. METHODS A total of 149,273 thin melanomas in the National Cancer Database were examined for their association of high-risk features of mitotic rate, ulceration, and Breslow depth with lymph node status. RESULTS Among 17,204 patients with thin melanomas with data on Breslow depth, ulceration, and mitotic rate who underwent a lymph node biopsy, there was a strong linear relationship between odds of having a positive lymph node and mitotic rate (R2 = 0.96, P < .0001, β = 3.31). The odds of having a positive node increased by 19% with each 1-point increase in mitotic rate (odds ratio, 1.19; 95% confidence interval, 1.17-1.21). Cases with negative nodes had a mean mitotic rate of 1.54 plus or minus 2.07 mitoses/mm2 compared with 3.30 plus or minus 3.54 mitoses/mm2 for those with positive nodes (P < .0001). LIMITATIONS The data collected do not allow for survival analyses. CONCLUSIONS Mitotic rate was strongly associated with the odds of having a positive lymph node and should continue to be reported on pathology reports.
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18
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Hendry S, Salgado R, Gevaert T, Russell PA, John T, Thapa B, Christie M, van de Vijver K, Estrada MV, Gonzalez-Ericsson PI, Sanders M, Solomon B, Solinas C, Van den Eynden GGGM, Allory Y, Preusser M, Hainfellner J, Pruneri G, Vingiani A, Demaria S, Symmans F, Nuciforo P, Comerma L, Thompson EA, Lakhani S, Kim SR, Schnitt S, Colpaert C, Sotiriou C, Scherer SJ, Ignatiadis M, Badve S, Pierce RH, Viale G, Sirtaine N, Penault-Llorca F, Sugie T, Fineberg S, Paik S, Srinivasan A, Richardson A, Wang Y, Chmielik E, Brock J, Johnson DB, Balko J, Wienert S, Bossuyt V, Michiels S, Ternes N, Burchardi N, Luen SJ, Savas P, Klauschen F, Watson PH, Nelson BH, Criscitiello C, O’Toole S, Larsimont D, de Wind R, Curigliano G, André F, Lacroix-Triki M, van de Vijver M, Rojo F, Floris G, Bedri S, Sparano J, Rimm D, Nielsen T, Kos Z, Hewitt S, Singh B, Farshid G, Loibl S, Allison KH, Tung N, Adams S, Willard-Gallo K, Horlings HM, Gandhi L, Moreira A, Hirsch F, Dieci MV, Urbanowicz M, Brcic I, Korski K, Gaire F, Koeppen H, Lo A, Giltnane J, Ziai J, Rebelatto MC, Steele KE, Zha J, Emancipator K, Juco JW, Denkert C, Reis-Filho J, Loi S, Fox SB. Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors. Adv Anat Pathol 2017; 24:311-335. [PMID: 28777143 PMCID: PMC5638696 DOI: 10.1097/pap.0000000000000161] [Citation(s) in RCA: 481] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Assessment of the immune response to tumors is growing in importance as the prognostic implications of this response are increasingly recognized, and as immunotherapies are evaluated and implemented in different tumor types. However, many different approaches can be used to assess and describe the immune response, which limits efforts at implementation as a routine clinical biomarker. In part 1 of this review, we have proposed a standardized methodology to assess tumor-infiltrating lymphocytes (TILs) in solid tumors, based on the International Immuno-Oncology Biomarkers Working Group guidelines for invasive breast carcinoma. In part 2 of this review, we discuss the available evidence for the prognostic and predictive value of TILs in common solid tumors, including carcinomas of the lung, gastrointestinal tract, genitourinary system, gynecologic system, and head and neck, as well as primary brain tumors, mesothelioma and melanoma. The particularities and different emphases in TIL assessment in different tumor types are discussed. The standardized methodology we propose can be adapted to different tumor types and may be used as a standard against which other approaches can be compared. Standardization of TIL assessment will help clinicians, researchers and pathologists to conclusively evaluate the utility of this simple biomarker in the current era of immunotherapy.
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Affiliation(s)
- Shona Hendry
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels, Belgium
- Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - Thomas Gevaert
- Department of Development and Regeneration, Laboratory of Experimental Urology, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Prudence A. Russell
- Department of Anatomical Pathology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Pathology, University of Melbourne, Parkville, Australia
| | - Tom John
- Department of Medical Oncology, Austin Health, Heidelberg, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- School of Cancer Medicine, La Trobe University, Bundoora, Australia
| | - Bibhusal Thapa
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Michael Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Koen van de Vijver
- Divisions of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M. Valeria Estrada
- Department of Pathology, School of Medicine, University of California, San Diego, USA
| | | | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Cinzia Solinas
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gert GGM Van den Eynden
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pathology, GZA Ziekenhuizen, Antwerp, Belgium
| | - Yves Allory
- Université Paris-Est, Créteil, France
- INSERM, UMR 955, Créteil, France
- Département de pathologie, APHP, Hôpital Henri-Mondor, Créteil, France
| | - Matthias Preusser
- Department of Medicine, Clinical Division of Oncology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes Hainfellner
- Institute of Neurology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Pruneri
- European Institute of Oncology, Milan, Italy
- University of Milan, School of Medicine, Milan, Italy
| | - Andrea Vingiani
- European Institute of Oncology, Milan, Italy
- University of Milan, School of Medicine, Milan, Italy
| | - Sandra Demaria
- New York University Medical School, New York, USA
- Perlmutter Cancer Center, New York, USA
| | - Fraser Symmans
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Laura Comerma
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Sunil Lakhani
- Centre for Clinical Research and School of Medicine, The University of Queensland, Brisbane, Australia
- Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Seong-Rim Kim
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Stuart Schnitt
- Cancer Research Institute and Department of Pathology, Beth Israel Deaconess Cancer Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Cecile Colpaert
- Department of Pathology, GZA Ziekenhuizen, Sint-Augustinus, Wilrijk, Belgium
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan J. Scherer
- Academic Medical Innovation, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - Robert H. Pierce
- Cancer Immunotherapy Trials Network, Central Laboratory and Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Nicolas Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frederique Penault-Llorca
- Department of Surgical Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
- University of Auvergne UMR1240, Clermont-Ferrand, France
| | - Tomohagu Sugie
- Department of Surgery, Kansai Medical School, Hirakata, Japan
| | - Susan Fineberg
- Montefiore Medical Center, Bronx, New York, USA
- The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Soonmyung Paik
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
- Severance Biomedical Science Institute and Department of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ashok Srinivasan
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Andrea Richardson
- Harvard Medical School, Boston, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, USA
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Providence, USA
- Warren Alpert Medical School of Brown University, Providence, USA
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland
- Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jane Brock
- Harvard Medical School, Boston, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, USA
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA
- Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Justin Balko
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA
- Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Stephan Wienert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
- VMscope GmbH, Berlin, Germany
| | - Veerle Bossuyt
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Stefan Michiels
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Nils Ternes
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | | | - Stephen J. Luen
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Savas
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter H. Watson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Brad H. Nelson
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
- Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sandra O’Toole
- The Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia
- Australian Clinical Labs, Bella Vista, Australia
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roland de Wind
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fabrice André
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Sud, Kremlin-Bicêtre, France
| | - Magali Lacroix-Triki
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Mark van de Vijver
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Federico Rojo
- Pathology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Giuseppe Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Shahinaz Bedri
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, USA
| | - David Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Torsten Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Stephen Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baljit Singh
- Department of Pathology, New York University Langone Medical Centre, New York, USA
| | - Gelareh Farshid
- Directorate of Surgical Pathology, SA Pathology, Adelaide, Australia
- Discipline of Medicine, Adelaide University, Adelaide, Australia
| | | | | | - Nadine Tung
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Sylvia Adams
- New York University Medical School, New York, USA
- Perlmutter Cancer Center, New York, USA
| | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugo M. Horlings
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Leena Gandhi
- Perlmutter Cancer Center, New York, USA
- Dana-Farber Cancer Institute, Boston, USA
| | - Andre Moreira
- Pulmonary Pathology, New York University Center for Biospecimen Research and Development, New York University, New York, USA
| | - Fred Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maria Urbanowicz
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, Austria
| | - Konstanty Korski
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Fabien Gaire
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Hartmut Koeppen
- Research Pathology, Genentech Inc., South San Francisco, USA
| | - Amy Lo
- Research Pathology, Genentech Inc., South San Francisco, USA
- Department of Pathology, Stanford University, Palo Alto, USA
| | | | - James Ziai
- Research Pathology, Genentech Inc., South San Francisco, USA
| | | | | | - Jiping Zha
- Translational Sciences, MedImmune, Gaithersberg, USA
| | | | | | - Carsten Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Sherene Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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19
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Histopathologic review of negative sentinel lymph node biopsies in thin melanomas: an argument for the routine use of immunohistochemistry. Melanoma Res 2017; 27:369-376. [DOI: 10.1097/cmr.0000000000000361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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20
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Durham AB, Schwartz JL, Lowe L, Zhao L, Johnson AG, Harms KL, Bichakjian CK, Orsini AP, McLean SA, Bradford CR, Cohen MS, Johnson TM, Sabel MS, Wong SL. The natural history of thin melanoma and the utility of sentinel lymph node biopsy. J Surg Oncol 2017; 116:1185-1192. [PMID: 28715140 DOI: 10.1002/jso.24765] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/21/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Current literature may overestimate the risk of nodal metastasis from thin melanoma due to reporting of data only from lesions treated with SLNB. Our objective was to define the natural history of thin melanoma, assessing the likelihood of nodal disease, in order to guide selection for SLNB. METHODS Retrospective review. The primary outcome was the rate of nodal disease. Clinicopathologic factors were evaluated to find associations with nodal disease. RESULTS Five hundred and twelve lesions, follow up available for 488 (median: 48 months). Lesions treated with WLE/SLNB compared to WLE alone were more likely to have high-risk features. The rate of nodal disease was higher in the WLE/SLNB group (24 positive SLNB, five false-negative SLNB with nodal recurrence: 10.2%) compared to WLE alone (four nodal recurrences: 2.0%). Univariate analysis showed age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm2 , and ulceration were associated with nodal disease. Multivariate analysis confirmed the association of age ≤45 and ulceration. CONCLUSIONS SLNB for melanoma 0.75-0.99 mm should be considered in patients age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm2 , and/or with ulceration. Thin melanoma <0.85 mm without high-risk features may be treated with WLE alone.
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Affiliation(s)
- Alison B Durham
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Jennifer L Schwartz
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Lori Lowe
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Kelly L Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Amy P Orsini
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Mark S Cohen
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan.,Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan.,Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael S Sabel
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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21
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Magno RJ, Perper M, Eber AE, Cervantes J, Verne SH, Tsatalis J, Nouri K. Cells to Surgery Quiz: May 2017. J Invest Dermatol 2017; 137:e55. [PMID: 30477723 DOI: 10.1016/j.jid.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J Magno
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Perper
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ariel E Eber
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jessica Cervantes
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sebastian H Verne
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John Tsatalis
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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22
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Ferris LK, Farberg AS, Middlebrook B, Johnson CE, Lassen N, Oelschlager KM, Maetzold DJ, Cook RW, Rigel DS, Gerami P. Identification of high-risk cutaneous melanoma tumors is improved when combining the online American Joint Committee on Cancer Individualized Melanoma Patient Outcome Prediction Tool with a 31-gene expression profile-based classification. J Am Acad Dermatol 2017; 76:818-825.e3. [PMID: 28110997 DOI: 10.1016/j.jaad.2016.11.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A significant proportion of patients with American Joint Committee on Cancer (AJCC)-defined early-stage cutaneous melanoma have disease recurrence and die. A 31-gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described. OBJECTIVE We sought to compare accuracy of the GEP in combination with risk determined using the web-based AJCC Individualized Melanoma Patient Outcome Prediction Tool. METHODS GEP results from 205 stage I/II cutaneous melanomas with sufficient clinical data for prognostication using the AJCC tool were classified as low (class 1) or high (class 2) risk. Two 5-year overall survival cutoffs (AJCC 79% and 68%), reflecting survival for patients with stage IIA or IIB disease, respectively, were assigned for binary AJCC risk. RESULTS Cox univariate analysis revealed significant risk classification of distant metastasis-free and overall survival (hazard ratio range 3.2-9.4, P < .001) for both tools. In all, 43 (21%) cases had discordant GEP and AJCC classification (using 79% cutoff). Eleven of 13 (85%) deaths in that group were predicted as high risk by GEP but low risk by AJCC. LIMITATIONS Specimens reflect tertiary care center referrals; more effective therapies have been approved for clinical use after accrual. CONCLUSIONS The GEP provides valuable prognostic information and improves identification of high-risk melanomas when used together with the AJCC online prediction tool.
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Affiliation(s)
- Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | | | | | | | | | | | | | | | - Darrell S Rigel
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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23
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Rashed H, Flatman K, Bamford M, Teo KW, Saldanha G. Breslow density is a novel prognostic feature in cutaneous malignant melanoma. Histopathology 2017; 70:264-272. [PMID: 27502743 PMCID: PMC6207337 DOI: 10.1111/his.13060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/06/2016] [Indexed: 12/12/2022]
Abstract
AIMS In 1970, Breslow described his eponymously named thickness measurement. No-one has sought to enhance the Breslow thickness (BT). The aim of this study was to demonstrate a proof of concept that the density of melanoma cells at the position where the BT is measured is a morphological prognostic biomarker, which we name the Breslow density (BD). The hypothesis was that the BD has prognostic value for overall survival (OS) and is independent of the BT. METHODS AND RESULTS We analysed 100 cutaneous melanomas, and followed REMARK guidelines. The BD was the estimated percentage dermal area occupied by melanoma cells in a specified location. The BT and BD had a strong correlation (P = 2.1 × 10-11 ) but, despite this, they were independent prognostic factors for OS in Cox regression [BD hazard ratio (HR) 1.03, P = 0.001849; and BT HR 1.09, P = 0.000146]. This was corroborated by an independent effect on melanoma-specific survival. We assessed whether the BT and BD could be combined into a Breslow score. A prognostic index based on Cox regression coefficients was used, and this showed a marginal improvement in predicted 5-year survival as compared with the BT alone (area under the curve of 94.8% versus 96.7%). CONCLUSIONS We show a proof of concept that the BD represents a novel morphological prognostic biomarker that is independent of the BT, and that there is potential to combine these into a Breslow score. Larger studies are needed to validate the BD, but the simplicity of this biomarker makes it a strong candidate for translation to clinical practice.
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Affiliation(s)
- Hala Rashed
- University Hospitals of Leicester, Department of Cellular Pathology, East Midlands Pathology Services (EMPATH)
| | | | - Mark Bamford
- University Hospitals of Leicester, Department of Cellular Pathology, East Midlands Pathology Services (EMPATH)
| | - Kah Wee Teo
- University of Leicester, Department of Cancer Studies
| | - Gerald Saldanha
- University Hospitals of Leicester, Department of Cellular Pathology, East Midlands Pathology Services (EMPATH)
- University of Leicester, Department of Cancer Studies
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24
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Karakousis G, Gimotty PA, Bartlett EK, Sim MS, Neuwirth MG, Fraker D, Czerniecki BJ, Faries MB. Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis. Ann Surg Oncol 2016; 24:952-959. [PMID: 27807729 DOI: 10.1245/s10434-016-5646-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although only a small proportion of thin melanomas result in lymph node metastasis, the abundance of these lesions results in a relatively large absolute number of patients with a diagnosis of nodal metastases, determined by either sentinel lymph node (SLN) biopsy or clinical nodal recurrence (CNR). METHODS Independent cohorts with thin melanoma and either SLN metastasis or CNR were identified at two melanoma referral centers. At both centers, SLN metastasis patients were included. At center 1, the CNR cohort included patients with initial negative clinical nodal evaluation followed by CNR. At center 2, the CNR cohort was restricted to those presenting in the era before the use of SLN biopsy. Uni- and multivariable analyses of melanoma-specific survival (MSS) were performed. RESULTS At center 1, 427 CNR patients were compared with 91 SLN+ patients. The 5- and 10-year survival rates in the SLN group were respectively 88 and 84 % compared with 72 and 49 % in the CNR group (p < 0.0001). The multivariate analysis showed age older than 50 years (hazard ratio [HR] 1.5; 95 % confidence interval [CI] 1.2-1.9), present ulceration (HR 1.9; 95 % CI 1.2-2.9), unknown ulceration (HR 1.6; 95 % CI 1.3-2.1), truncal site (HR 1.6; 95 % CI 1.2-2.2), and CNR (HR 3.3; 95 % CI 1.8-6.0) to be associated significantly with decreased MSS (p < 0.01 for each). The center 2 cohort demonstrated remarkably similar findings, with a 5-year MSS of 88 % in the SLN (n = 29) group and 76 % in the CNR group (n = 39, p = 0.09). CONCLUSION Patients with nodal metastases from thin melanomas have a substantial risk of melanoma death. This risk is lower among patients whose disease is discovered by SLN biopsy rather than CNR.
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Affiliation(s)
- Giorgos Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Phyllis A Gimotty
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Edmund K Bartlett
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Madalyn G Neuwirth
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas Fraker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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25
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Minami CA, Wayne JD, Yang AD, Martini MC, Gerami P, Chandra S, Kuzel TM, Winchester DP, Palis BE, Bilimoria KY. National Evaluation of Hospital Performance on the New Commission on Cancer Melanoma Quality Measures. Ann Surg Oncol 2016; 23:3548-3557. [DOI: 10.1245/s10434-016-5302-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Indexed: 11/18/2022]
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26
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Cordeiro E, Gervais MK, Shah PS, Look Hong NJ, Wright FC. Sentinel Lymph Node Biopsy in Thin Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2016; 23:4178-4188. [PMID: 26932710 DOI: 10.1245/s10434-016-5137-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Most patients with melanoma have a thin (≤1.00 mm) lesion. There is uncertainty as to which patients with thin melanoma should undergo sentinel lymph node (SN) biopsy. We sought to quantify the proportion of SN metastases in patients with thin melanoma and to determine the pooled effect of high-risk features of the primary lesion on SN positivity. METHODS Published literature between 1980 and 2015 was searched and critically appraised. Primary outcome was the proportion of SN metastases in patients with thin cutaneous melanoma. Secondary outcomes included the effect of high-risk pathological features of the primary lesion on the proportion of SN metastases. Summary measures were estimated by Mantel-Haenszel method using random effects meta-analyses. RESULTS Sixty studies (10,928 patients) met the criteria for inclusion. Pooled SN positivity was 4.5 % [95 % confidence interval (CI) 3.8-5.2 %]. Predictors of a positive SN were: thickness ≥0.75 mm [adjusted odds ratio (AOR) 1.90 (95 % CI 1.08-3.34); with a likelihood of SN metastases of 8.8 % (95 % CI 6.4-11.2 %)]; Clark level IV/V [AOR 2.24 (95 % CI 1.23-4.08); with a likelihood of 7.3 % (95 % CI 6.2-8.4 %)]; ≥1 mitoses/mm2 [AOR 6.64 (95 % CI 2.77-15.88); pooled likelihood 8.8 % (95 % CI 6.2-11.4 %)]; and the presence of microsatellites [unadjusted OR 6.94 (95 % CI 2.13-22.60); likelihood 26.6 % (95 % CI 4.3-48.9 %)]. CONCLUSIONS The pooled proportion of SN metastases in thin melanoma is 4.5 %. Thickness ≥0.75 mm, Clark level IV/V, mitoses, and microsatellites significantly increased the odds of SN positivity and should prompt strong consideration of SN biopsy.
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Affiliation(s)
- Erin Cordeiro
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Mai-Kim Gervais
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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27
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Molecular techniques for predicting behaviour in melanocytic neoplasms. Pathology 2016; 48:142-6. [PMID: 27020386 DOI: 10.1016/j.pathol.2015.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/11/2015] [Indexed: 11/24/2022]
Abstract
Molecular tools are rapidly emerging as novel tools for clinicians caring for cancer patients. Roles for these assays in melanocytic neoplasms include diagnosis for histologically ambiguous tumors, prognosis for conventional melanoma, and theragnosis for advanced disease. The introduction of these molecular strategies is timely, as different therapeutic options are rapidly developing to treat melanoma. With the development of new and effective therapeutic options, it is more critical than ever to improve the discrimination between patients with aggressive disease and those with more indolent tumours. In this review, we will evaluate the traditional staging of melanoma and what are the likely greatest opportunities for improvement with molecular strategies. We will explore a number of molecular assays that are now commercially available for the assessment of melanocytic neoplasms, which include techniques such as fluorescence in situ hybridisation, comparative genomic hybridisation, mRNA expression profiling and next generation sequencing, and discuss the optimal utilisation of each of these assays.
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28
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Guo J, Qin S, Liang J, Lin T, Si L, Chen X, Chi Z, Cui C, Du N, Fan Y, Gu K, Li F, Li J, Li Y, Liang H, Liu J, Lu M, Lu A, Nan K, Niu X, Pan H, Ren G, Ren X, Shu Y, Song X, Tao M, Wang B, Wei W, Wu D, Wu L, Wu A, Xu X, Zhang J, Zhang X, Zhang Y, Zhu H. Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition). ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:322. [PMID: 26734632 DOI: 10.3978/j.issn.2305-5839.2015.12.23] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jun Guo
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Shukui Qin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jun Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Tongyu Lin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lu Si
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohong Chen
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Zhihong Chi
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Chuanliang Cui
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Nan Du
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yun Fan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kangsheng Gu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Fang Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junling Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongheng Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Houjie Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jiwei Liu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Man Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiping Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kejun Nan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohui Niu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Hongming Pan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Guoxin Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiubao Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongqian Shu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xin Song
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Min Tao
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Baocheng Wang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Wenbin Wei
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Di Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lingying Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiwen Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaolin Xu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junyi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaoshi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yiping Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Huiyan Zhu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
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Abstract
The surgical management of melanoma has undergone considerable changes over the past several decades, as new strategies and treatments have become available. Surgeons play a pivotal role in all aspects of melanoma care: diagnostic, curative, and palliative. There is a high potential for cure in patients with early-stage melanoma and the selection of an appropriate operation is very important for this reason. Staging the nodal basin has become widespread since the adoption of sentinel lymph node biopsy (SLNB) for the management of melanoma. This operation provides the best prognostic information that is currently available for patients with melanoma. The surgeon plays a central role in the palliation of symptoms resulting from nodal disease and metastases, as melanoma has a propensity to spread to almost any site in the body.
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Affiliation(s)
- Vadim P Koshenkov
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA.
| | - Joe Broucek
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA
| | - Howard L Kaufman
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA
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30
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Caldarella A, Fancelli L, Manneschi G, Chiarugi A, Nardini P, Crocetti E. How staging of thin melanoma is changed after the introduction of TNM 7th edition: a population-based analysis. J Cancer Res Clin Oncol 2016; 142:73-6. [PMID: 26113451 DOI: 10.1007/s00432-015-2007-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In 2009, the American Joint Committee on Cancer (AJCC) incorporated the tumor mitotic rate in the melanoma pathological TNM staging system. To investigate the effect of this change on the pT1 substaging of primary cutaneous melanomas, we reclassified the cases collected by a cancer registry according to the 6th and the 7th editions of AJCC melanoma staging. METHODS Patients with pathological T1 melanoma diagnosed in the period 2000-2008 were selected from Tuscan Cancer Registry. The histological reports were reviewed and pT1 melanomas classified according to both the 6th and the 7th editions of the AJCC staging system. The shift of melanomas between pT1 substages was analyzed. RESULTS Among the 242 pT1 melanomas collected in the study period and with mitotic index available, there were 202 (83 % of all pT1) and 175 (72 %) pT1a, according to the 6th and the 7th editions of the AJCC melanoma staging, respectively. When the 7th edition was used, 20 % of all pT1a melanomas shifted to pT1b, and 32 % of all pT1b melanomas shifted to pT1a. A poor level agreement between the two TNM staging systems, measured by the Cohen's kappa coefficient, was found (K = 0.37). CONCLUSIONS The addition of mitotic activity to the pathological staging resulted in an increase in pT1b proportion and in a change in the classification of some cases. This modification could influence the clinical approach, with a different use of the sentinel lymph node biopsy, and underlines the role of mitosis evaluation in the management of thin melanoma patients.
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Affiliation(s)
- A Caldarella
- Cancer Prevention and Research Institute, Via Cosimo il Vecchio n. 2, 50141, Florence, Italy.
| | - L Fancelli
- Dermatology Section, Department of Surgery and Translational Medicine, School of Medicine, Florence, Italy
| | - G Manneschi
- Cancer Prevention and Research Institute, Via Cosimo il Vecchio n. 2, 50141, Florence, Italy
| | - A Chiarugi
- Screening and Cancer Prevention, Melanoma Prevention Service, Cancer Prevention and Research Institute, Florence, Italy
| | - P Nardini
- Screening and Cancer Prevention, Melanoma Prevention Service, Cancer Prevention and Research Institute, Florence, Italy
| | - E Crocetti
- Cancer Prevention and Research Institute, Via Cosimo il Vecchio n. 2, 50141, Florence, Italy
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31
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Wat H, Senthilselvan A, Salopek TG. A retrospective, multicenter analysis of the predictive value of mitotic rate for sentinel lymph node (SLN) positivity in thin melanomas. J Am Acad Dermatol 2015; 74:94-101. [PMID: 26542815 DOI: 10.1016/j.jaad.2015.09.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a paucity of studies to substantiate whether the presence of a single mitosis justifies sentinel lymph node (SLN) biopsy (SLNB) in thin melanomas. OBJECTIVE We sought to determine if mitotic rate is associated with SLNB outcome when taking into account other prognostic factors. METHODS All cases of melanoma that underwent SLNB in the province of Alberta, Canada, between 2007 and 2013 were reviewed through a provincial tumor database. RESULTS A total of 1072 patients fulfilled inclusion criteria. When analyzing all melanomas regardless of thickness, mitotic rate was a good predictor of SLN status. When stratified by Breslow thickness, only intermediate melanomas (1.01-2.0 mm) demonstrated a significant relationship between mitotic rate and positive SLN status (P = .010). For melanomas 1 mm or smaller, mitotic rate was not associated with SLN status. A statistically significant interaction was identified between Breslow thickness and mitotic rate such that for decreasing Breslow depth, the effect of mitotic rate on SLNB status diminished (P = .028). LIMITATIONS The study was retrospective in nature. There is underlying variability in mitotic rate reporting methods over time, and between different dermatopathologists. CONCLUSIONS Mitotic rate does not have unequivocal utility in predicting SLNB status in thin melanomas. There is a significant interaction between mitotic rate and Breslow depth, such that the predictive value of mitotic rate on SLN positivity may be dependent on Breslow thickness.
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Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Thomas G Salopek
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Zuluaga-Sepúlveda MA, Arellano-Mendoza I, Ocampo-Candiani J. [Update on surgical treatment of primary and metastatic cutaneous melanoma]. CIR CIR 2015; 84:77-84. [PMID: 26277601 DOI: 10.1016/j.circir.2015.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/10/2014] [Indexed: 11/27/2022]
Abstract
Melanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes. This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy. Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy.
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Affiliation(s)
| | - Ivonne Arellano-Mendoza
- Servicio de Dermatología, Hospital General de México Dr. Eduardo Liceaga, México D.F., México
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Hospital Universitario Dr. José E. González, Monterrey, Nuevo LeónMéxico.
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Meves A, Nikolova E, Heim JB, Squirewell EJ, Cappel MA, Pittelkow MR, Otley CC, Behrendt N, Saunte DM, Lock-Andersen J, Schenck LA, Weaver AL, Suman VJ. Tumor Cell Adhesion As a Risk Factor for Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. J Clin Oncol 2015; 33:2509-15. [PMID: 26150443 DOI: 10.1200/jco.2014.60.7002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Less than 20% of patients with melanoma who undergo sentinel lymph node (SLN) biopsy based on American Society of Clinical Oncology/Society of Surgical Oncology recommendations are SLN positive. We present a multi-institutional study to discover new molecular risk factors associated with SLN positivity in thin and intermediate-thickness melanoma. PATIENTS AND METHODS Gene clusters with functional roles in melanoma metastasis were discovered by next-generation sequencing and validated by quantitative polymerase chain reaction using a discovery set of 73 benign nevi, 76 primary cutaneous melanoma, and 11 in-transit melanoma metastases. We then used polymerase chain reaction to quantify gene expression in a model development cohort of 360 consecutive thin and intermediate-thickness melanomas and a validation cohort of 146 melanomas. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. Logic and logistic regression analyses were used to develop a model for the likelihood of SLN metastasis from molecular, clinical, and histologic variables. RESULTS ITGB3, LAMB1, PLAT, and TP53 expression were associated with SLN metastasis. The predictive ability of a model that included these molecular variables in combination with clinicopathologic variables (patient age, Breslow depth, and tumor ulceration) was significantly greater than a model that only considered clinicopathologic variables and also performed well in the validation cohort (area under the curve, 0.93; 95% CI, 0.87 to 0.97; false-positive and false-negative rates of 22% and 0%, respectively, using a 10% cutoff for predicted SLN metastasis risk). CONCLUSION The addition of cell adhesion-linked gene expression variables to clinicopathologic variables improves the identification of patients with SLN metastases within 90 days of melanoma diagnosis.
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Affiliation(s)
- Alexander Meves
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Ekaterina Nikolova
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joel B Heim
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Edwin J Squirewell
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark A Cappel
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark R Pittelkow
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Clark C Otley
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nille Behrendt
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte M Saunte
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Lock-Andersen
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Louis A Schenck
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amy L Weaver
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vera J Suman
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
The worldwide incidence of melanoma continues to rise. It is a leading cause of cancer death and the second leading cause of loss of productive years of life. Although the diagnosis of melanoma is straightforward, there remain many controversies regarding treatment and surveillance. This chapter addresses important questions in melanoma treatment such as sentinel lymph node biopsy, what to do with a positive sentinel lymph node, margins of resection for melanoma, radiation for primary, nodal and metastatic melanoma, and routine use imaging. Through this chapter, the evidence for these controversial subjects and the barriers to resolution will be elucidated.
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Affiliation(s)
- Maria C Russel
- Department of Surgery, Emory University, Atlanta, GA, USA,
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Leiter U, Eigentler T, Garbe C. Follow-up in patients with low-risk cutaneous melanoma: is it worth it? Melanoma Manag 2014; 1:115-125. [PMID: 30190817 PMCID: PMC6094616 DOI: 10.2217/mmt.14.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Follow-up examinations in melanoma aim to detect recurrences or secondary melanomas in an early phase of development. Follow-up guidelines that have been developed in many European countries, the USA and Australia show varying recommendations and are controversial, especially in patients with melanomas of 1.0 mm tumor thickness or less. This group contains 50-70% of all melanoma patients and the majority is unlikely to develop recurrences. On the other hand, within this entity, subgroups at higher risk for recurrences can be defined who require a more intense follow-up. This article discusses recommendations for the frequency, duration and costs of follow-up in low-risk melanoma patients. Patient preferences are addressed and a risk-adapted follow-up scheme is proposed.
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Affiliation(s)
- Ulrike Leiter
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Thomas Eigentler
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
| | - Claus Garbe
- Center of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Liebermeisterstr. 25, 72076 Tuebingen, Germany
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A review of sentinel lymph node biopsy for thin melanoma. Ir J Med Sci 2014; 184:119-23. [PMID: 25366817 DOI: 10.1007/s11845-014-1221-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/27/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Although there is a lack of established survival benefit of sentinel lymph node biopsy (SLNB), this technique has been increasingly applied in the staging of patients with thin (≤1.00 mm) melanoma (T1Nx), without clear supportive evidence. METHODS We review the guidelines and available literature on the indications and rationale for performing SLNB in thin melanoma. RESULTS As a consequence of the paucity of evidence of SLNB in thin melanoma, there is considerable variability in the guidelines. It is difficult to define clinicopathologic factors that reliably predict the presence of nodal metastasis. SLNB does not yet inform management in thin melanoma to improve survival outcome. CONCLUSION Based on available evidence, high risk patients with melanomas between 0.75 and 1.00 mm may be appropriate candidates to be considered for SLN biopsy after discussing the likelihood of finding evidence of nodal progression, the risks of sentinel node biopsy, and the lack of proven survival benefit from any form of surgical nodal staging.
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Maurichi A, Miceli R, Camerini T, Mariani L, Patuzzo R, Ruggeri R, Gallino G, Tolomio E, Tragni G, Valeri B, Anichini A, Mortarini R, Moglia D, Pellacani G, Bassoli S, Longo C, Quaglino P, Pimpinelli N, Borgognoni L, Bergamaschi D, Harwood C, Zoras O, Santinami M. Prediction of survival in patients with thin melanoma: results from a multi-institution study. J Clin Oncol 2014; 32:2479-85. [PMID: 25002727 DOI: 10.1200/jco.2013.54.2340] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Cutaneous melanoma incidence is increasing. Most new cases are thin (≤ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. PATIENTS AND METHODS Data from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. RESULTS Median follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3% (95% CI, 83.4% to 87.2%). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, presence of LVI, and regression ≥ 50%. Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, and LVI (all P = .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). CONCLUSION Our findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.
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Affiliation(s)
- Andrea Maurichi
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece.
| | - Rosalba Miceli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Tiziana Camerini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Luigi Mariani
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberto Patuzzo
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberta Ruggeri
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Gianfranco Gallino
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Elena Tolomio
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Gabrina Tragni
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Barbara Valeri
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Andrea Anichini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberta Mortarini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Daniele Moglia
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Giovanni Pellacani
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Sara Bassoli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Caterina Longo
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Pietro Quaglino
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Nicola Pimpinelli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Lorenzo Borgognoni
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Daniele Bergamaschi
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Catherine Harwood
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Odysseas Zoras
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Mario Santinami
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
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de Waal A, van Harten-Gerritsen A, Aben K, Kiemeney L, van Rossum M, Blokx W. Impact of mitotic activity on the pathological substaging of pT1 cutaneous melanoma. Br J Dermatol 2014; 170:874-7. [DOI: 10.1111/bjd.12898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- A.C. de Waal
- Department of Dermatology (370); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
- Department for Health Evidence (133); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
| | - A.S. van Harten-Gerritsen
- Department for Health Evidence (133); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
- Division of Human Nutrition; Wageningen University; P.O. Box 9101 NL-6700 HB Wageningen the Netherlands
| | - K.K.H. Aben
- Department for Health Evidence (133); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
- Comprehensive Cancer Centre the Netherlands; P.O. Box 19079 NL-3501 DB Utrecht the Netherlands
| | - L.A.L.M. Kiemeney
- Department for Health Evidence (133); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
- Department of Urology (659); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
| | - M.M. van Rossum
- Department of Dermatology (370); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
| | - W.A.M. Blokx
- Department of Pathology (812); Radboud University Medical Center; P.O. Box 9101 NL-6500 HB Nijmegen the Netherlands
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Kupferman ME, Kubik MW, Bradford CR, Civantos FJ, Devaney KO, Medina JE, Rinaldo A, Stoeckli SJ, Takes RP, Ferlito A. The role of sentinel lymph node biopsy for thin cutaneous melanomas of the head and neck. Am J Otolaryngol 2014; 35:226-32. [PMID: 24439782 DOI: 10.1016/j.amjoto.2013.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
From 18% to 35% of cutaneous melanomas are located in the head and neck, and nearly 70% are thin (Breslow thickness ≤ 1 mm). Sentinel lymph node biopsy (SLNB) has an established role in staging of intermediate-thickness melanomas, however its use in thin melanomas remains controversial. In this article, we review the literature regarding risk factors for occult nodal metastasis in thin cutaneous melanoma of the head and neck (CMHN). Based on the current literature, we recommend SLNB for all lesions with Breslow thickness ≥ 0.75 mm, particularly when accompanied by adverse features including mitotic rate ≥ 1 per mm(2), ulceration, and extensive regression. SLNB should also be strongly considered in younger patients (e.g. < 40 years old), especially in the presence of additional adverse features. All patients who do not proceed with sentinel lymph node biopsy must be carefully followed to monitor for regional relapse.
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Affiliation(s)
- Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Mark W Kubik
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Jesus E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Sandro J Stoeckli
- Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Durham AB, Wong SL. Sentinel lymph node biopsy in melanoma: controversies and current guidelines. Future Oncol 2014; 10:429-42. [DOI: 10.2217/fon.13.245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT: Melanoma is a global health problem and the incidence of this disease is rising. While localized melanoma has an excellent prognosis, regional and distant disease is associated with much poorer outcomes. Optimal treatment for clinically localized melanoma requires surgical control of the primary site and accurate staging of the regional nodal basin with sentinel lymph node biopsy (SLNB). While further data are required to determine if SLNB is associated with a survival advantage, currently available data supports the use of SLNB for staging of appropriate patients and the procedure may offer benefits beyond staging. This article reviews current data that shapes guidelines regarding patient selection for SLNB in melanoma and highlights areas where performing this procedure remains controversial.
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Affiliation(s)
- Alison B Durham
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sandra L Wong
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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Schatton T, Scolyer RA, Thompson JF, Mihm MC. Tumor-infiltrating lymphocytes and their significance in melanoma prognosis. Methods Mol Biol 2014; 1102:287-324. [PMID: 24258985 DOI: 10.1007/978-1-62703-727-3_16] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The role of the tumor-infiltrating lymphocyte (TIL) and its relationship to prognosis has been most extensively studied in malignant melanoma. The purpose of this chapter is to discuss in depth the immunobiology and molecular aspects of lymphocyte function in general and particularly TIL function in the context of antimelanoma immunity. Emphasis is placed upon the role of these inflammatory mediators in the enhancement and impairment of progression of this often fatal human cancer. In addition, the analysis of TILs in melanoma and their direct relationship to prognosis as well as their effect on the positivity of the sentinel lymph node will be discussed. Furthermore, details of lymph node responses to metastatic melanomas and their prognostic significance will be clarified. Finally, the importance of TILs for the evaluation of therapeutic response and how TIL immunobiology could critically inform the design of novel melanoma immunotherapeutic protocols will be elucidated.
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Affiliation(s)
- Tobias Schatton
- Department of Dermatology, Brigham and Women's Hospital and Transplantation Research Center, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
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Abstract
The incidence of melanoma is increasing worldwide. Melanomas represent 3 percent of all skin cancers but 65 percent of skin cancer deaths. Melanoma is now the fifth most common cancer diagnosed in the United States. Excisional biopsy should be performed for lesions suspicious for melanoma. The pathologist's report provides essential information for surgical treatment; the most important information is the Breslow depth of the lesion. In addition to wide surgical excision of the primary lesion, sentinel lymph node biopsy is the standard of care for early identification of regional metastasis. Nodal metastasis found in the sentinel lymph node biopsy should be followed with a complete lymph node dissection. Although surgery remains the primary treatment of melanoma, recent advances in chemotherapy may offer further survival benefits to patients with metastatic disease.
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Freeman SR, Gibbs BB, Brodland DG, Zitelli JA. Prognostic Value of Sentinel Lymph Node Biopsy Compared with that of Breslow Thickness: Implications for Informed Consent in Patients with Invasive Melanoma. Dermatol Surg 2013; 39:1800-12. [DOI: 10.1111/dsu.12351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Han D, Zager JS, Shyr Y, Chen H, Berry LD, Iyengar S, Djulbegovic M, Weber JL, Marzban SS, Sondak VK, Messina JL, Vetto JT, White RL, Pockaj B, Mozzillo N, Charney KJ, Avisar E, Krouse R, Kashani-Sabet M, Leong SP. Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. J Clin Oncol 2013; 31:4387-93. [PMID: 24190111 DOI: 10.1200/jco.2013.50.1114] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma. PATIENTS AND METHODS Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (≤ 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome. RESULTS SLN metastases were detected in 65 (5.2%) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P = .03), Clark level ≥ IV (P = .05), and ulceration (P = .01) significantly predicted SLN metastasis with 6.3%, 7.0%, and 11.6% of the patients with these respective characteristics having SLN disease. Melanomas < 0.75 mm had positive SLN rates of < 5% regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P = .001). CONCLUSION Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2%) occur in melanomas ≥ 0.75 mm, with 6.3% of these patients having SLN disease, whereas in melanomas < 0.75 mm, SLN metastasis rates are < 5%. By using a 5% metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas < 0.75 mm.
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Affiliation(s)
- Dale Han
- Dale Han, Jonathan S. Zager, Sanjana Iyengar, Mia Djulbegovic, Jaimie L. Weber, Suroosh S. Marzban, Vernon K. Sondak, and Jane L. Messina, Moffitt Cancer Center, Tampa; Eli Avisar, University of Miami, Miami, FL; Yu Shyr, Heidi Chen, and Lynne D. Berry, Vanderbilt University School of Medicine, Nashville, TN; John T. Vetto, Oregon Health and Science University, Portland, OR; Richard L. White, Carolinas Medical Center, Charlotte, NC; Barbara Pockaj, Mayo Clinic, Scottsdale; Robert Krouse, Southern Arizona Veterans Administration Health Care System, Tucson, AZ; Nicola Mozzillo, Istituto Nazionale dei Tumori-Fondazione Pascale, Naples, Italy; Kim James Charney, St Joseph Hospital, Orange; and Mohammed Kashani-Sabet and Stanley P. Leong, California Pacific Medical Center and Research Institute, San Francisco, CA
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A 10-year, single-institution analysis of clinicopathologic features and sentinel lymph node biopsy in thin melanomas. J Am Acad Dermatol 2013; 69:693-699. [DOI: 10.1016/j.jaad.2013.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 11/21/2022]
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Mori M, Sugiura M, Kono M, Matsumoto T, Sawada M, Yokota K, Yasue S, Shibata S, Sakakibara A, Nakamura S, Tomita Y, Akiyama M. Clinicopathologic analysis of 66 Japanese thin melanomas with metastasis of sentinel or regional lymph node. J Cutan Pathol 2013; 40:1027-34. [DOI: 10.1111/cup.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 12/31/2010] [Accepted: 02/02/2011] [Indexed: 01/02/2023]
Affiliation(s)
- Mayumi Mori
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Mitsuhiro Sugiura
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
- Department of Surgical Pathology, School of Medicine; Nagoya University; Nagoya Japan
- Department of Dermatology; Tosei General Hospital; Seto Japan
| | - Michihiro Kono
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Takaaki Matsumoto
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Masaki Sawada
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Kenji Yokota
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Satoshi Yasue
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Shinichi Shibata
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Akihiro Sakakibara
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Shigeo Nakamura
- Department of Surgical Pathology, School of Medicine; Nagoya University; Nagoya Japan
| | - Yasushi Tomita
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
| | - Masashi Akiyama
- Department of Dermatology, School of Medicine; Nagoya University; Nagoya Japan
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Bartlett EK, Gimotty PA, Sinnamon AJ, Wachtel H, Roses RE, Schuchter L, Xu X, Elder DE, Ming M, Elenitsas R, Guerry D, Kelz RR, Czerniecki BJ, Fraker DL, Karakousis GC. Clark level risk stratifies patients with mitogenic thin melanomas for sentinel lymph node biopsy. Ann Surg Oncol 2013; 21:643-9. [PMID: 24121883 DOI: 10.1245/s10434-013-3313-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND The role for sentinel lymph node biopsy (SLNB) in patients with thin melanoma (≤1 mm) remains controversial. We examined a large cohort of patients with thin melanoma to better define predictors of SLN positivity. METHODS From 1995 to 2011, 781 patients with thin primary melanoma and evaluable clinicopathologic data underwent SLNB at our institution. Predictors of SLN positivity were determined using univariate and multivariate regression analyses, and patients were risk-stratified using a classification and regression tree (CART) analysis. RESULTS In the study cohort (n = 781), 29 patients (3.7%) had nodal metastases. In the univariate analysis, mitotic rate [odds ratio (OR) = 8.11, p = 0.005], Clark level (OR 4.04, p = 0.003), and thickness (OR 3.33, p = 0.011) were significantly associated with SLN positivity. In the multivariate analysis, MR (OR 7.01) and level IV-V (OR 3.45) remained significant predictors of SLN positivity. CART analysis initially stratified lesions by mitotic rate; nonmitogenic lesions (n = 273) had a 0.7% SLN positivity rate versus 5.6% in mitogenic lesions (n = 425). Mitogenic lesions were further stratified by Clark level; patients with level II-III had a 2.9% SLN positivity rate (n = 205) versus 8.2% with level IV-V (n = 220). With median follow-up of 6.3 years, five SLN-negative patients developed nodal recurrence and four SLN-positive patients died of disease. CONCLUSIONS SLN positivity is low in patients with thin melanoma (3.7%) and exceedingly so in nonmitogenic lesions (0.7%). Appreciable rates of SLN positivity can be identified in patients with mitogenic lesions, particularly with concurrent level IV-V regardless of thickness. These factors may guide appropriate selection of patients with thin melanoma for SLNB.
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Affiliation(s)
- Edmund K Bartlett
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA,
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Mozzillo N, Pennacchioli E, Gandini S, Caracò C, Crispo A, Botti G, Lastoria S, Barberis M, Verrecchia F, Testori A. Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol 2013; 20:2780-6. [PMID: 23720068 DOI: 10.1245/s10434-012-2826-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although sentinel node biopsy (SNB) has become standard of care in patients with melanoma, its use in patients with thin or thick melanomas remains a matter of debate. METHODS This was a retrospective analysis of patients with thin (≤1 mm) or thick (≥4 mm) melanomas who underwent SNB at two Italian centers between 1998 and 2011. The associations of clinicopathologic features with sentinel lymph node positive status and overall survival (OS) were analyzed. RESULTS In 492 patients with thin melanoma, sentinel node was positive for metastatic melanoma in 24 (4.9 %) patients. No sentinel node positivity was detected in patients with primary tumor thickness <0.3 mm. Mitotic rate was the only factor significantly associated with sentinel node positivity (p = 0.0001). Five-year OS was 81 % for patients with positive sentinel node and 93 % for negative sentinel node (p = 0.001). In 298 patients with thick melanoma, 39 % of patients had positive sentinel lymph nodes (median Breslow thickness 5 mm). In patients with positive sentinel node, 93 % had mitotic rate >1/mm(2). Five-year OS was 49 % for patients with positive sentinel lymph nodes and 56 % for patients with negative sentinel nodes (p = 0.005). CONCLUSIONS The rate of sentinel node positivity in patients with thin melanoma was 4.9 %. The only clinicopathologic factor related to node positivity was mitotic rate. Given its prognostic importance, SNB should be considered in such patients. SNB should also be the standard method for melanoma ≥4 mm, not only for staging, but also for guiding therapeutic decisions.
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Affiliation(s)
- Nicola Mozzillo
- Istituto Nazionale per lo Studio e la cura dei tumori Fondazione G.Pascale IRCCS, Naples, Italy.
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Venna SS, Thummala S, Nosrati M, Leong SP, Miller JR, Sagebiel RW, Kashani-Sabet M. Analysis of sentinel lymph node positivity in patients with thin primary melanoma. J Am Acad Dermatol 2013. [DOI: 10.1016/j.jaad.2012.08.045] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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