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The Prognostic Significance of Nonsentinel Lymph Node Metastasis in Melanoma

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival.

Materials and methods

Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥1.0 mm in Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free survival (DFS) and overall survival (OS) were computed by Kaplan–Meier analysis; univariate and multivariate analyses were performed to identify factors associated with differences in survival among groups.

Results

A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6% for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4%, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence of ulceration, Clark level ≥ IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not.

Conclusions

NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive lymph nodes or the lymph node ratio.

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Acknowledgment

The authors would like to sincerely thank Deborah Hulsewede, Sherri Matthews, Wanda Greenwell, Pam Harlan, Alex Scroggins, and Ivan Deyahs for their dedication and hard work in managing the Sunbelt Melanoma Trial. We also express gratitude to Advertek, Inc., for their expert data management. Finally, we thank all of the patients, centers, and investigators who participated in the trial. This work is supported by a grant from Schering Oncology-Biotech. Schering Oncology-Biotech had no access to data, no input into the analysis of the data, and has not participated in the preparation or review of this manuscript.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Louisville, James Graham Brown Cancer Center, Louisville, KY, USA

    Russell E. Brown MD, Robert C. G. Martin MD, PhD, Kelly M. McMasters MD, PhD & Charles R. Scoggins MD, MBA

  2. Department of Surgical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Merrick I. Ross MD

  3. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Michael J. Edwards MD

  4. Department of Surgery, LDS Hospital, Salt Lake City, UT, USA

    R. Dirk Noyes MD

  5. Department of Surgery, Lakeland Regional Cancer Center, Lakeland, FL, USA

    Douglas S. Reintgen MD

  6. Advertek, Inc., Louisville, KY, USA

    Lee J. Hagendoorn MBA

  7. Department of Statistics, University of Kentucky, Lexington, KY, USA

    Arnold J. Stromberg PhD

Authors
  1. Russell E. Brown MD
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  2. Merrick I. Ross MD
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  3. Michael J. Edwards MD
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  4. R. Dirk Noyes MD
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  5. Douglas S. Reintgen MD
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  6. Lee J. Hagendoorn MBA
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  7. Arnold J. Stromberg PhD
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  8. Robert C. G. Martin MD, PhD
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  9. Kelly M. McMasters MD, PhD
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  10. Charles R. Scoggins MD, MBA
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Corresponding author

Correspondence to Charles R. Scoggins MD, MBA.

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Brown, R.E., Ross, M.I., Edwards, M.J. et al. The Prognostic Significance of Nonsentinel Lymph Node Metastasis in Melanoma. Ann Surg Oncol 17, 3330–3335 (2010). https://doi.org/10.1245/s10434-010-1208-8

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  • DOI: https://doi.org/10.1245/s10434-010-1208-8

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