Influence of Sentinel Lymph Node Tumor Burden on Survival in Melanoma

• Published in: Annals of surgical oncology Vol. 17; no. 4; pp. 1152 - 1158
• Main Authors: Francischetto, Thiago, Spector, Nelson, Neto Rezende, Jose Francisco, de Azevedo Antunes, Marcelle, de Oliveira Romano, Sergio, Small, Isabele A., Gil Ferreira, Carlos
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.04.2010; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Melanoma - mortality; Melanoma - secondary; Melanomas; Middle Aged; Oncology; Prognosis; Retrospective Studies; Sentinel Lymph Node Biopsy; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Surgery; Surgical Oncology; Survival Rate; Tumor Burden; Young Adult; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Lymphatic Mapping; Positive Sentinel Lymph Node; Overall Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-009-0884-8

Background Completion lymph node dissection (CLND) is the standard procedure for patients with positive sentinel lymph nodes (SLN). With extensive pathological workup, increased numbers of small metastatic deposits are detected in SLN. This study evaluated the prognostic significance of SLN metastatic deposits ≤ 0.2 mm in patients treated in a referral cancer center in Brazil. Methods Patients with stage I/II melanoma, consecutively submitted to a SLN procedure by the same surgeon from 2000 to 2006, were evaluated. All positive SLN and randomly selected negative cases were reviewed by two pathologists. Different prognostic factors and SLN tumor burden were recorded. Additional positive non-SLN after CLND, and disease outcome were evaluated. Results Of 381 patients who underwent SLN biopsy, 103 (27%) were positive. The mean/median Breslow tumor thickness in the overall group was 3.4/2.0 mm and in the SLN positive patients was 5.72/4.0 mm. Among these patients, 48 (47%) had metastatic deposits >2 mm (macrometastasis), 49 (47%) had metastatic deposits ≤2 mm but >0.2 mm (micrometastasis), and 6 (6%) had metastatic deposits ≤0.2 mm (submicrometastasis). Additional positive non-SLN were detected in 29% of patients with macrometastasis, in 25% of patients with micrometastasis, and in 0% of patients with submicrometastases. At median follow-up of 35 months, the estimated 3-year overall survival was 92% for negative SLN, 64% for micrometastases, 53% for macrometastases, and 100% for submicrometastases ( P  < 0.001). Conclusion In the present study, patients with SLN metastatic deposits ≤0.2 mm had no additional positive non-SLNs, and no recurrences or deaths were recorded, suggesting that their prognosis is equivalent to that of patients with negative SLN.