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Xia Q, Ma Q, Zhu J, Gu L, Zhou F. Prognostic factors in postoperative patients with cutaneous melanoma: a systematic review and meta-analysis. Am J Cancer Res 2024; 14:1947-1956. [PMID: 38859868 PMCID: PMC11162687 DOI: 10.62347/sqzt7285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/18/2024] [Indexed: 06/12/2024] Open
Abstract
Cutaneous melanoma is a prevalent tumor associated with a poor prognosis. This systematic review and meta-analysis aimed to identify and evaluate prognostic factors for patients with cutaneous melanoma following surgery, thereby providing crucial insights for enhancing patient outcomes. We searched PubMed, Embase, Cochrane Library, CINAHL, and Web of Science for studies on postoperative prognostic factors of cutaneous melanoma up to March 2024. Literature screening, data extraction, and quality assessment were performed, followed by meta-analysis using RevMan 5.3 software. Trial Sequential Analysis (TSA) was conducted with Stata 17 software to verify the robustness of the findings. Eleven studies encompassing 27,352 patients were included. The meta-analysis identified several prognostic factors impacting disease-specific survival post-surgery: age over 50 years (HR=1.05, 95% CI: 1.02-1.08), female gender (HR=0.71, 95% CI: 0.57-0.87), Breslow thickness greater than 2 mm (HR=1.11, 95% CI: 1.06-1.17), presence of ulceration (HR=2.06, 95% CI: 1.63-2.60), and positive sentinel lymph node (HR=3.03, 95% CI: 2.50-3.66). TSA confirmed the adequacy of the sample size. Aggressive treatment strategies are recommended for patients exhibiting these characteristics to improve prognosis and extend 5-year survival rates.
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Affiliation(s)
- Qi Xia
- Department of PICC, Day Chemotherapy Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Qinghua Ma
- Department of Nursing, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Jiuqun Zhu
- Department of Pharmacy, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Lu Gu
- Department of Radiation, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Fengling Zhou
- Department of Pediatrics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
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Jeremić J, Radenović K, Jurišić M, Suđecki B, Marinković M, Mihaljević J, Radosavljević I, Jovanović M, Stojanović M, Milić N, Pavlović V, Stojičić M, Inić Z, Jović M. Primary Melanoma Histopathologic Predictors of Sentinel Lymph Node Positivity: A Proposed Scoring System for Risk Assessment and Patient Selection in a Clinical Setting. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1921. [PMID: 38003969 PMCID: PMC10673032 DOI: 10.3390/medicina59111921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The careful selection of adequate SLNB candidates not only aims at reducing the surgical risk while identifying SLN metastasis, but also plays a crucial role in identifying the patients eligible for adjuvant therapy. Objectives: The purpose of our study was to investigate the clinical and histologic aspects of primary melanomas that correlate with the likelihood of a positive SLNB result. Materials and Methods: A total of 101 primary melanoma patients who underwent sentinel lymph node biopsies were included in the study. General patient demographics were obtained as well as localization and melanoma-specific characteristics of primary melanoma from histologic reports in addition to data derived from SLNB melanoma histopathology reports. Results: The patients with positive SLN results had a statistically significant increased Breslow thickness (3.8 mm vs. 1.97 mm, p = 0.002), higher mitotic index rate (5/mm2 vs. 2/mm2, p = 0.009), as well as the presence of ulceration (68.4% vs. 31.6%, p = 0.007). Univariate regression analysis showed the Breslow thickness (p = 0.008), the mitotic index rate (p = 0.054), the presence of ulceration (p = 0.009), as well as the pT3-4 stage (p = 0.009) to be significant predictors of SLN positivity. The optimal cut-off values for Breslow thickness and the number of mitoses scores were determined based on ROC curve analysis. Using the Breslow thickness, mitotic index rate, presence of ulceration, and pT3-4 stage significant coefficients from the univariate regression model, a chance prediction score was developed. Conclusions: The newly developed and proposed scoring system can aid in patient selection for SLN biopsy by facilitating a more efficient risk assessment in the detection of lymph node metastases in melanoma patients.
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Affiliation(s)
- Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Branko Suđecki
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Jovan Mihaljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Ivan Radosavljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Marina Stojanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Center for Anesthesia, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nataša Milić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Vedrana Pavlović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Zorka Inić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
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Țăpoi DA, Derewicz D, Gheorghișan-Gălățeanu AA, Dumitru AV, Ciongariu AM, Costache M. The Impact of Clinical and Histopathological Factors on Disease Progression and Survival in Thick Cutaneous Melanomas. Biomedicines 2023; 11:2616. [PMID: 37892990 PMCID: PMC10604442 DOI: 10.3390/biomedicines11102616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Thick cutaneous melanomas (Breslow depth > 4 mm) are locally advanced tumors, generally associated with poor prognosis. Nevertheless, these tumors sometimes display unpredictable behavior. This study aims to analyze clinical and histopathological features that can influence the prognosis of thick melanomas. This is a retrospective study on 94 thick primary cutaneous melanomas diagnosed between 2012 and 2018 that were followed-up for at least five years to assess disease progression and survival. We evaluated the age, gender, tumor location, histological subtype, Breslow depth, Clark level, resection margins, mitotic index, the presence/absence of ulceration, necrosis, regression, microsatellites, neurotropism, lymphovascular invasion, and the pattern of tumor-infiltrating lymphocytes, and their association with disease progression and survival. By conducting univariate analysis, we found that progression-free survival (PFS) was significantly associated with female gender, the superficial spreading melanoma (SSM) subtype, mitotic index, necrosis, microsatellites, and perineural invasion. Overall survival (OS) was significantly associated with female gender, Breslow depth, SSM subtype, necrosis, microsatellites, and perineural invasion. Through multivariate Cox proportional hazards regression, we found that the only factors associated with PFS were Breslow depth, necrosis, microsatellites, and perineural invasion, while the factors associated with OS were Breslow depth, necrosis, microsatellites, and perineural invasion. Certain histopathological features such as Breslow depth, necrosis, microsatellites, and perineural invasion could explain differences in disease evolution. This is one of the first studies to demonstrate an association between necrosis and perineural invasion and outcomes in patients with thick melanomas. By identifying high-risk patients, personalized therapy can be provided for improved prognosis.
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Affiliation(s)
- Dana Antonia Țăpoi
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Diana Derewicz
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Pediatric Hematology and Oncology, Marie Sklodowska Curie Clinical Emergency Hospital, 041447 Bucharest, Romania
| | - Ancuța-Augustina Gheorghișan-Gălățeanu
- Department of Cellular and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Adrian Vasile Dumitru
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Ana Maria Ciongariu
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
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Han D, Han G, Morrison S, Leong SP, Kashani-Sabet M, Vetto J, White R, Schneebaum S, Pockaj B, Mozzillo N, Sondak VK, Zager JS. Factors predicting survival in thick melanoma: Do all thick melanomas have the same prognosis? Surgery 2020; 168:518-526. [PMID: 32669204 DOI: 10.1016/j.surg.2020.04.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unknown whether all thick melanomas share the same prognostic features. We present a large, multi-institutional study on thick melanoma, evaluating for factors prognostic of survival. METHODS We queried the database of the Sentinel Lymph Node Working Group for patients with thick melanoma (>4 mm) who had a sentinel lymph node biopsy from 1993 to 2018. Clinicopathologic characteristics were correlated with overall survival. RESULTS There were 1,235 patients with a median follow-up of 28 months. Median thickness was 5.9 mm, with 713, 356, and 166 cases having a thickness of >4 to 6, >6 to 10, and >10 mm, respectively. Ulceration was seen in 51.2% of cases, while sentinel lymph node metastases were seen in 439 of 1,235 (35.5%) cases. For melanomas >4 to 6 mm, age, thickness, ulceration, lymphovascular invasion, and sentinel lymph node metastasis were correlated with overall survival (all P < .05), but for melanomas >6 to 10 mm, only sex and sentinel lymph node metastasis were prognostic of overall survival (both P < .05). For melanomas >10 mm, only sentinel lymph node metastasis predicted overall survival on multivariable analyses (P < .05). CONCLUSION Prognostic markers of overall survival for thick melanoma include thickness, ulceration, and sentinel lymph node metastasis, but also include other unique factors such as lymphovascular invasion. Moreover, certain prognostic markers for survival are associated with different subgroups of thick melanoma, which vary based on thickness group.
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Affiliation(s)
- Dale Han
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR.
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX
| | - Steven Morrison
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR
| | - Stanley P Leong
- Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, CA
| | - Mohammed Kashani-Sabet
- Department of Dermatology, California Pacific Medical Center and Research Institute, San Francisco, CA
| | - John Vetto
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR
| | - Richard White
- Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC
| | | | | | - Nicola Mozzillo
- Department of Melanoma and Soft Tissues, Instituto Tumori Napoli Fondazione G. Pascale, Italy
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
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