Prognostic Significance of Sentinel Lymph Node Status in Thick Primary Melanomas (> 4 mm)
(2023) In Annals of Surgical Oncology 30(13). p.8026-8033- Abstract
BACKGROUND: The key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1-4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (> 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors.
METHODS: Data for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness... (More)
BACKGROUND: The key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1-4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (> 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors.
METHODS: Data for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness greater than 1 mm in Sweden between 2007 and 2020 were retrieved from the Swedish Melanoma Registry, a large prospective population-based registry. A multivariable Cox proportional hazard model for melanoma-specific survival (MSS) was constructed based on Breslow thickness stratified for SLN status.
RESULTS: The study enrolled 10,491 patients, 1943 of whom had a Breslow thickness greater than 4 mm (pT4). A positive SLN was found for 34% of these pT4 patients. The 5-year MSS was 71%, and the 10-year MSS was 62%. There was a statistically significant difference in MSS between the patients with a positive SLN and those with a negative SLN (hazard ratio of 2.4 (95% confidence interval CI 1.6-3.5) for stage T4a and 2.0 (95% CI 1.6-2.5) for satage T4b.
CONCLUSION: Sentinel lymph node status gives important prognostic information also for patients with thick (> 4 mm) melanomas, and the authors thus recommend that clinical guidelines be updated to reflect this.
(Less)
- author
- Holmberg, Carl-Jacob ; Mikiver, Rasmus ; Isaksson, Karolin LU ; Ingvar, Christian LU ; Moncrieff, Marc ; Nielsen, Kari LU ; Ny, Lars ; Lyth, Johan and Olofsson Bagge, Roger LU
- organization
- publishing date
- 2023-08-14
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Annals of Surgical Oncology
- volume
- 30
- issue
- 13
- pages
- 8026 - 8033
- publisher
- Springer
- external identifiers
-
- scopus:85167832991
- pmid:37574516
- ISSN
- 1534-4681
- DOI
- 10.1245/s10434-023-14050-w
- language
- English
- LU publication?
- yes
- additional info
- © 2023. The Author(s).
- id
- 44e67cf5-0035-40a4-8f27-69da8651f699
- date added to LUP
- 2023-10-12 08:38:36
- date last changed
- 2024-04-19 02:14:14
@article{44e67cf5-0035-40a4-8f27-69da8651f699, abstract = {{<p>BACKGROUND: The key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1-4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (> 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors.</p><p>METHODS: Data for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness greater than 1 mm in Sweden between 2007 and 2020 were retrieved from the Swedish Melanoma Registry, a large prospective population-based registry. A multivariable Cox proportional hazard model for melanoma-specific survival (MSS) was constructed based on Breslow thickness stratified for SLN status.</p><p>RESULTS: The study enrolled 10,491 patients, 1943 of whom had a Breslow thickness greater than 4 mm (pT4). A positive SLN was found for 34% of these pT4 patients. The 5-year MSS was 71%, and the 10-year MSS was 62%. There was a statistically significant difference in MSS between the patients with a positive SLN and those with a negative SLN (hazard ratio of 2.4 (95% confidence interval CI 1.6-3.5) for stage T4a and 2.0 (95% CI 1.6-2.5) for satage T4b.</p><p>CONCLUSION: Sentinel lymph node status gives important prognostic information also for patients with thick (> 4 mm) melanomas, and the authors thus recommend that clinical guidelines be updated to reflect this.</p>}}, author = {{Holmberg, Carl-Jacob and Mikiver, Rasmus and Isaksson, Karolin and Ingvar, Christian and Moncrieff, Marc and Nielsen, Kari and Ny, Lars and Lyth, Johan and Olofsson Bagge, Roger}}, issn = {{1534-4681}}, language = {{eng}}, month = {{08}}, number = {{13}}, pages = {{8026--8033}}, publisher = {{Springer}}, series = {{Annals of Surgical Oncology}}, title = {{Prognostic Significance of Sentinel Lymph Node Status in Thick Primary Melanomas (> 4 mm)}}, url = {{http://dx.doi.org/10.1245/s10434-023-14050-w}}, doi = {{10.1245/s10434-023-14050-w}}, volume = {{30}}, year = {{2023}}, }