The Asco Post

Nonsentinel Lymph Node Positivity Appears to be Significant Prognostic Factor in Patients with Melanoma

By The ASCO Post
Posted: 7/31/2013 4:46:49 PM
Last Updated: 7/31/2013 4:46:49 PM

Key Points:
  • Factors predictive of nonsentinel lymph node positivity included older age, greater Breslow thickness, and ulceration.
  • Median overall survival was 178 months for the sentinel lymph node–only positive group and 42.2 months for the nonsentinel lymph node positive group.
  • Nonsentinel lymph node positivity had a strong association with recurrence, shorter overall survival, and shorter melanoma-specific survival.

Nonsentinel lymph node positivity appears to be a significant prognostic factor in patients with stage III melanoma, according to a study by Anna M. Leung, MD, of the John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, California, and colleagues. The study was published online today in JAMA Surgery.

Regional lymph node metastasis in patients with primary cutaneous melanoma is the most important prognostic factor for tumor recurrence and survival. Sentinel lymph node biopsy has become the one of the most important clinical tools in the staging of melanoma, according to the study background.

Study Details

Among a total of 4,223 patients who underwent sentinel lymph node biopsy from 1986 to 2012, a total of 329 had a tumor-positive sentinel lymph node. Of these 329 patients, 250 (76%) had no additional positive nodes and 79 patients (24%) had a tumor-positive nonsentinel lymph node.

According to the study results, factors predictive of nonsentinel lymph node positivity included older age, greater Breslow thickness, and ulceration.

Median overall survival was 178 months for the sentinel lymph node–only positive group and 42.2 months for the nonsentinel lymph node positive group (5-year overall survival, 72.3% and 46.4%, respectively). Median melanoma-specific survival was not reached for the sentinel lymph node–only positive group and was 60 months for the nonsentinel lymph node positive group (5-year melanoma-specific survival, 77.8% and 49.5%, respectively). Nonsentinel lymph node positivity had a strong association with recurrence, shorter overall survival, and shorter melanoma-specific survival.

Next Steps

“We propose that, for the next iteration of the staging system, the committee performs an analysis of the independent prognostic impact of nonsentinel lymph node status,” the authors wrote. “Should that analysis confirm the findings of our series and others, this simple, readily available data point should be included in the next staging system.”

The study was funded in part by fellowship funding from the Harold McAlister Charitable Foundation and a grant from the National Cancer Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.

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