Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?
As only about 20% of sentinel node (SN) positive melanoma patients have additional non-SN lymph node involvement in the Completion Lymph Node Dissection (CLND) specimen, we tried to identify a SN positive patient group, which can be spared CLND. Micro anatomic analyses of metastatic SNs were performed to identify patient/tumor and/or SN factors predicting additional non-SN positivity as well as disease-free and overall survival. SN positivity was found in 77 of 262 stage I/II patients, included into a prospective database (10/97-5/04). Of 74 patients pathology material was available for re-evaluation. Micro anatomic analyses categorized topography of SN-metastases, Starz classification and amount of SN tumor burden. Additional non-SN positivity, DFS, OS and was calculated for all analyses. Mean Breslow thickness was 3.5 mm (0.8-12.0); mean FU was 35 (6-81) months. There was no additional non-SN positivity for SN-micrometastases <0.1 mm. Topography of SN involvement had no impact on OS. Estimated 5-year OS rates for the different groups of <0.1 mm, 0.1-1.0 mm and >1.0 mm SN tumor burden were 100%, 63% and 35% respectively. Distant metastases were exceedingly rare (1/16 = 6.3%) in <0.1 mm SN-positive patients. On multivariate analysis the SN tumor burden was the most important prognostic factor for DFS (P = 0.005) and OS (P = 0.03). Distant metastasis-free survival was identical (91%) to the 5-yr OS of SN negative patients, the estimated 5-yr OS was 100% for these patients and additional non-SN positivity was not observed. Therefore, our data suggest that patients with sub-micrometastases (<0.1 mm) in the SN may be judged as SN negative, as non-stage III, and are highly unlikely to benefit from CLND, which we no longer recommend.
|Keywords||Adolescent, Adult, Aged, Disease-Free Survival, Female, Humans, Lymphatic Metastasis/*diagnosis, Male, Melanoma/*diagnosis/mortality/*pathology/therapy, Middle Aged, Prognosis, Sentinel Lymph Node Biopsy, Skin Neoplasms/*diagnosis/mortality/*pathology/therapy, Survival Analysis|
|Persistent URL||dx.doi.org/10.1093/annonc/mdl176, hdl.handle.net/1765/14898|
|Journal||Annals of Oncology|
|Note||Free full text at PubMed|
van Akkooi, A.C.J, de Wilt, J.H.W, Verhoef, C, Schmitz, P.I.M, van Geel, A.N, Eggermont, A.M.M, & Kliffen, M. (2006). Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?. Annals of Oncology, 17(10), 1578–1585. doi:10.1093/annonc/mdl176