Nonsentinel Lymph Node Status Independently Predicts Melanoma-Specific Survival in Patients With Two or Three Positive Nodes
In a study reported in the Journal of Clinical Oncology, Pasquali et al assessed the prognostic utility of nonsentinel lymph node status in patients with cutaneous melanoma. They found that nonsentinel lymph node status was a significant independent predictor of melanoma-specific survival in patients with two or three positive nodes.
Study Details
The study involved retrospective collection of clinicopathologic data from 1,538 patients with positive sentinel lymph status who underwent complete lymph node dissection at nine Italian centers. Multivariable Cox regression survival analysis was used to identify independent prognostic factors. A meta-analysis including reports from the literature was also performed.
Nonsentinel Lymph Node and Poorer Survival
Overall, nonsentinel lymph node metastasis was observed in 353 patients (23%). Median follow-up was 45 months. On multivariate analysis, nonsentinel lymph node metastasis was associated with significantly poorer melanoma-specific survival (hazard ratio [HR] = 1.34, P < .001). Other significant predictors were older age (P < .001), male sex (P < .001), and thicker (P < .001) and ulcerated (P < .001) primary tumors. American Joint Committee on Cancer (AJCC) TNM staging, Clark level of invasion, and number of excised nodes were not independent predictors.
Significant in Patients With Two or Three Positive Nodes
Separate analysis of the association in patients with AJCC stage N2 (two or three positive nodes) and stage N3 (four or more positive nodes) showed that nonsentinel lymph node metastasis was a significant predictor of poorer survival in patients with two or three positive nodes (HR =1.39, P = .013), together with older age (HR = 1.02, P = .003), male sex (HR = 1.87, P = .009), greater tumor thickness (HR =1.08, P = .007), and fewer excised nodes (HR = 0.97, P = .016). In patients with four or more positive nodes, nonsentinel lymph node metastasis was not a significant prognostic factor (HR = 0.75, P = .470), with tumor thickness being the only factor significantly associated with melanoma-specific survival (HR = 1.16, P <.001).
In a meta-analysis that pooled study data with data from two additional studies providing information on survival status associated with nonsentinel lymph node in patients with two or three positive nodes (620 total patients, 284 with positive nonsentinel lymph node and 284 with negative nonsentinel lymph node ), nonsentinel lymph node metastasis was a significant predictor of overall survival (summary HR = 1.59, P < .001).
The investigators concluded, “These findings support the independent prognostic value of the nonsentinel lymph node status in patients with two to three positive lymph nodes, suggesting that this information should be considered for the routine staging in patients with melanoma.”
Simone Mocellin, MD, PhD, of University of Padova, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Italian Melanoma Intergroup. The study authors reported no potential conflicts of interest.
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