The prognostic significance of nonsentinel lymph node metastasis in melanoma

Russell E. Brown, Merrick I. Ross, Michael J. Edwards, R. Dirk Noyes, Douglas S. Reintgen, Lee J. Hagendoorn, Arnold J. Stromberg, Robert C.G. Martin, Kelly M. McMasters, Charles R. Scoggins

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival. Materials and methods: Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥1.0 mm in Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free survival (DFS) and overall survival (OS) were computed by Kaplan-Meier analysis; univariate and multivariate analyses were performed to identify factors associated with differences in survival among groups. Results: A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6% for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4%, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence of ulceration, Clark level ≥ IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not. Conclusions: NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive lymph nodes or the lymph node ratio.

Original languageEnglish (US)
Pages (from-to)3330-3335
Number of pages6
JournalAnnals of surgical oncology
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2010

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Melanoma
Lymph Nodes
Neoplasm Metastasis
Survival
Disease-Free Survival
Multivariate Analysis
Survival Rate
Sentinel Lymph Node Biopsy
Kaplan-Meier Estimate
Lymph Node Excision
Sentinel Lymph Node

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Brown, R. E., Ross, M. I., Edwards, M. J., Noyes, R. D., Reintgen, D. S., Hagendoorn, L. J., ... Scoggins, C. R. (2010). The prognostic significance of nonsentinel lymph node metastasis in melanoma. Annals of surgical oncology, 17(12), 3330-3335. https://doi.org/10.1245/s10434-010-1208-8

The prognostic significance of nonsentinel lymph node metastasis in melanoma. / Brown, Russell E.; Ross, Merrick I.; Edwards, Michael J.; Noyes, R. Dirk; Reintgen, Douglas S.; Hagendoorn, Lee J.; Stromberg, Arnold J.; Martin, Robert C.G.; McMasters, Kelly M.; Scoggins, Charles R.

In: Annals of surgical oncology, Vol. 17, No. 12, 01.12.2010, p. 3330-3335.

Research output: Contribution to journalArticle

Brown, RE, Ross, MI, Edwards, MJ, Noyes, RD, Reintgen, DS, Hagendoorn, LJ, Stromberg, AJ, Martin, RCG, McMasters, KM & Scoggins, CR 2010, 'The prognostic significance of nonsentinel lymph node metastasis in melanoma', Annals of surgical oncology, vol. 17, no. 12, pp. 3330-3335. https://doi.org/10.1245/s10434-010-1208-8
Brown, Russell E. ; Ross, Merrick I. ; Edwards, Michael J. ; Noyes, R. Dirk ; Reintgen, Douglas S. ; Hagendoorn, Lee J. ; Stromberg, Arnold J. ; Martin, Robert C.G. ; McMasters, Kelly M. ; Scoggins, Charles R. / The prognostic significance of nonsentinel lymph node metastasis in melanoma. In: Annals of surgical oncology. 2010 ; Vol. 17, No. 12. pp. 3330-3335.
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abstract = "Background: We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival. Materials and methods: Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥1.0 mm in Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free survival (DFS) and overall survival (OS) were computed by Kaplan-Meier analysis; univariate and multivariate analyses were performed to identify factors associated with differences in survival among groups. Results: A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6{\%} for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4{\%}, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence of ulceration, Clark level ≥ IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not. Conclusions: NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive lymph nodes or the lymph node ratio.",
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T1 - The prognostic significance of nonsentinel lymph node metastasis in melanoma

AU - Brown, Russell E.

AU - Ross, Merrick I.

AU - Edwards, Michael J.

AU - Noyes, R. Dirk

AU - Reintgen, Douglas S.

AU - Hagendoorn, Lee J.

AU - Stromberg, Arnold J.

AU - Martin, Robert C.G.

AU - McMasters, Kelly M.

AU - Scoggins, Charles R.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Background: We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival. Materials and methods: Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥1.0 mm in Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free survival (DFS) and overall survival (OS) were computed by Kaplan-Meier analysis; univariate and multivariate analyses were performed to identify factors associated with differences in survival among groups. Results: A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6% for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4%, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence of ulceration, Clark level ≥ IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not. Conclusions: NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive lymph nodes or the lymph node ratio.

AB - Background: We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival. Materials and methods: Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥1.0 mm in Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free survival (DFS) and overall survival (OS) were computed by Kaplan-Meier analysis; univariate and multivariate analyses were performed to identify factors associated with differences in survival among groups. Results: A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6% for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4%, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence of ulceration, Clark level ≥ IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not. Conclusions: NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive lymph nodes or the lymph node ratio.

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