Annals of Oncology Advance Access originally published online on September 12, 2006
Annals of Oncology 2006 17(10):1578-1585; doi:10.1093/annonc/mdl176
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© 2006 European Society for Medical Oncology
sarcomas and melanoma |
Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?
1 Department of Surgical Oncology, Erasmus University Medical Center–Daniel den Hoed Cancer Center
2 Department of Statistics, Erasmus University Medical Center–Daniel den Hoed Cancer Center
3 Department of Pathology, Erasmus University Medical Center–Daniel den Hoed Cancer Center, The Netherlands
* Correspondence to: Prof A. M. M. Eggermont, Department of Surgical Oncology, Erasmus University Medical Center–Daniel den Hoed Cancer Center, 301 Groene Hilledijk, 3075 EA, Rotterdam, the Netherlands. Tel: +31-10-4391851; Fax: +31-10-4391011; E-mail: a.m.m.eggermont{at}erasmusmc.nl
As only about 20% of sentinel node (SN) positive melanoma patients have additional non-SN lymph node involvement in the Completion Lymph Node Dissection (CLND) specimen, we tried to identify a SN positive patient group, which can be spared CLND. Micro anatomic analyses of metastatic SNs were performed to identify patient/tumor and/or SN factors predicting additional non-SN positivity as well as disease-free and overall survival. SN positivity was found in 77 of 262 stage I/II patients, included into a prospective database (10/97–5/04). Of 74 patients pathology material was available for re-evaluation. Micro anatomic analyses categorized topography of SN-metastases, Starz classification and amount of SN tumor burden. Additional non-SN positivity, DFS, OS and was calculated for all analyses. Mean Breslow thickness was 3.5 mm (0.8–12.0); mean FU was 35 (6–81) months. There was no additional non-SN positivity for SN-micrometastases <0.1 mm. Topography of SN involvement had no impact on OS. Estimated 5-year OS rates for the different groups of <0.1 mm, 0.1–1.0 mm and >1.0 mm SN tumor burden were 100%, 63% and 35% respectively. Distant metastases were exceedingly rare (1/16 = 6.3%) in <0.1 mm SN-positive patients. On multivariate analysis the SN tumor burden was the most important prognostic factor for DFS (P = 0.005) and OS (P = 0.03). Distant metastasis-free survival was identical (91%) to the 5-yr OS of SN negative patients, the estimated 5-yr OS was 100% for these patients and additional non-SN positivity was not observed. Therefore, our data suggest that patients with sub-micrometastases (<0.1 mm) in the SN may be judged as SN negative, as non-stage III, and are highly unlikely to benefit from CLND, which we no longer recommend.
Key words: sentinel node, melanoma, pathology, micro anatomic, prognosis
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