Diversity of Stage III Melanoma in the Era of Sentinel Lymph Node Biopsy

• Published in: Annals of surgical oncology Vol. 20; no. 3; pp. 956 - 963
• Main Authors: Egger, Michael E., Callender, Glenda G., McMasters, Kelly M., Ross, Merrick I., Martin, Robert C. G., Edwards, Michael J., Urist, Marshall M., Noyes, R. Dirk, Sussman, Jeffrey J., Reintgen, Douglas S., Stromberg, Arnold J., Scoggins, Charles R.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2013; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Melanoma - mortality; Melanoma - pathology; Melanoma - therapy; Melanomas; Middle Aged; Neoplasm Staging; Oncology; Prognosis; Prospective Studies; Risk Factors; Sentinel Lymph Node Biopsy; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Surgery; Surgical Oncology; Survival Rate; Young Adult; Sentinel Lymph Node; Completion Lymphadenectomy; Sentinel Lymph Node Biopsy; Positive Sentinel Lymph Node Biopsy; Overall Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2701-z

Background Sentinel lymph node (SLN) biopsy for melanoma often detects minimal nodal tumor burden. Although all node-positive patients are considered stage III, there is controversy regarding the necessity of adjuvant therapy for all patients with tumor-positive SLN. Methods Post hoc analysis was performed of a prospective multi-institutional study of patients with melanoma ≥ 1.0 mm Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for patients with SLN metastasis. Kaplan–Meier analysis of disease-free survival (DFS) and overall survival (OS) was performed. Univariate and multivariate Cox regression analyses were performed. Classification and regression tree (CART) analysis also was performed. Results A total of 509 patients with tumor-positive SLN were evaluated. Independent risk factors for worse OS included thickness, age, gender, presence of ulceration, and tumor-positive non-SLN (nodal metastasis found on completion lymphadenectomy). As the number of tumor-positive SLN and the total number of tumor-positive nodes (SLN and non-SLN) increased, DFS and OS worsened on Kaplan–Meier analysis. On CART analysis, the 5-year OS rates ranged from 84.9 % (women with thickness < 2.1 mm, age < 59 years, no ulceration, and tumor-negative non-SLN) to 14.3 % (men with thickness ≥ 2.1 mm, age ≥ 59 years, ulceration present, and tumor-positive non-SLN). Six distinct subgroups were identified with 5-year OS in excess of 70 %. Conclusions Stage III melanoma in the era of SLN is associated with a very wide range of prognosis. CART analysis of prognostic factors allows discrimination of low-risk subgroups for which adjuvant therapy may not be warranted.