Prognostic significance of molecular staging study of sentinel lymph nodes by reverse transcriptase-polymerase chain reaction for tyrosinase in melanoma patients

• Published in: Annals of surgical oncology Vol. 13; no. 7; pp. 910 - 918
• Main Authors: Mangas, Cristina, Hilari, Josep M, Paradelo, Cristina, Rex, Jordi, Fernández-Figueras, Maria Teresa, Fraile, Manel, Alastrue, Antoni, Ferrándiz, Carlos
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.07.2006
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor - genetics; Biomarkers, Tumor - metabolism; Female; Follow-Up Studies; Humans; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis - diagnosis; Male; Melanoma - enzymology; Melanoma - genetics; Melanoma - secondary; Middle Aged; Monophenol Monooxygenase - genetics; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - metabolism; Neoplasm Staging; Prognosis; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger - genetics; RNA, Messenger - metabolism; RNA, Neoplasm - metabolism; Sentinel Lymph Node Biopsy; Skin Neoplasms - enzymology; Skin Neoplasms - genetics; Skin Neoplasms - pathology; Survival Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/ASO.2006.12.010

We performed this study to evaluate the clinical effect of microscopic and submicroscopic metastases in sentinel lymph nodes (SLNs) from patients with early-stage melanoma. Patients with confirmed cutaneous melanoma (American Joint Committee on Cancer stages I and II) underwent standard lymphoscintigraphy and SLN biopsy. Serial sections were divided between routine histopathology with hematoxylin and eosin plus immunohistochemistry for HMB-45 and molecular analysis by nested reverse transcriptase-polymerase chain reaction (RT-PCR) assay for tyrosinase (using beta-actin as a control). Of 180 patients analyzed (318 SLNs), 38 (21%) patients had positive SLN(s) by routine hematoxylin and eosin and immunohistochemistry (microscopic disease; group 1), and 142 (79%) had negative histological results. Analysis by RT-PCR detected tyrosinase in at least 1 SLN from 124 (69%) patients. Among patients with histologically negative SLN(s), tyrosinase was detected in 86 (48%) patients (submicroscopic disease; group 2), whereas 40 (22%) patients had negative results by both histology and RT-PCR (group 3). Sixteen (9%) patients had histologically negative SLNs and ambiguous RT-PCR results (group 4). Among 138 patients in the analysis of recurrence (mean follow-up, 45 months), only 18 patients had a recurrence: 11 (31%) of 35 in group 1, 5 (10%) of 51 in group 2, and 2 (5%) of 37 in group 3. No recurrences were seen in group 4. Only group 1 had a significantly shorter disease-free survival and overall survival compared with the other groups. After a long follow-up period, molecular upstaging by tyrosinase RT-PCR failed to detect a subgroup of patients with an increased probability of recurrence.