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Sentinel Node Number Predicts 5-Year Melanoma Survival in Database Analysis: Presented at SSO

By Carole Bullock

CHICAGO -- March 20, 2008 -- The risk of metastatic melanoma risk is higher for patients with 1 or more positive sentinel lymph nodes (SLNs) compared with patients who have negative SNLs, according to a large database analysis presented here at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium.

"The 5-year survival of patients with positive sentinel nodes was 70.6% in those with only 1 positive node and 55.6% when 2 or more nodes were positive," said investigator Alessandro Testori, MD, Director, Melanoma and Soft Tissue Sarcoma Division, European Institute of Oncology, Milan, Italy.

The observational multicentre study examined SNL biopsies and reported the false negative (FN) rate, possible correlations between prognostic factors and SLN status, and prognosis after biopsy.

The study was conducted in 23 centres in Italy and included 1,313 consecutive patients enrolled from January 2000 to December 2002 with primary cutaneous melanoma located in the lower limbs or upper limbs, head, neck, or trunk.

Lymphoscintigraphy, blue dye lymphatic mapping, pathological examination, and follow-up were performed according to the study protocol.

The SLN identification rate was 99.3%. Mean number of SLNs was 2.0 (range 1–17) and only 1 node was removed in 45.4 %, Dr. Testori reported in a poster session on March 14.

Multivariate Cox regression analysis indicated that SLN status was the most important prognostic factor (hazard ratio = 3.08), followed by gender and age, as well as Breslow and Clark level (which indicates the invasiveness of the tumour).

Ulceration, which was associated with survival when considered as a single factor (P < .0001) had no impact on survival in the multivariate analysis.

The positivity and false-negative rates were 16.9% and 18.4%, respectively (median follow-up, 4.5 years).

Multivariate logistic regression analysis showed that the frequency of positive nodes increased with increasing Breslow's thickness (P < .0001) and Clark level (P = .047).

Positive SLN status was associated with female sex (P = .007) and melanoma regression (P = .0002). Presence of macrometastasis was associated with an increasing number of positive SLNs (P = .009).

The false-negative rate of SLN biopsy was approximately 20%.

"Regression in the primary melanoma seems to be a protective factor from metastasis in [SLNs]," Dr. Testori reported. "Macrometastases seem to influence the number of positive nodes."

SLN biopsy makes it possible to assess the patient's prognosis, he explained. The researchers identified 3 groups of patients with different prognoses, he said. After 7 years, survival was about 90% among patients with negative SLN who did not develop metastases during follow-up, whereas patients with only 1 positive SLN and completion node dissection had a rate of about 44% survival. Patients with more than 1 positive SN after SLN biopsy and completion lymph node dissection-positive patients with false-negative SLN had a survival rate of about 40%, Dr. Testori said.


[Presentation title: Clinical Outcome After Sentinel Node Biopsy in 1,313 Patients With Cutaneous Melanoma: An Italian Multicentric Study (SOLISM–IMI). Abstract P101]

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