Annals of Oncology Advance Access published online on September 12, 2006
Annals of Oncology, doi:10.1093/annonc/mdl176
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1 Department of Surgical Oncology, Erasmus University Medical Center-Daniel den Hoed Cancer Center
* To whom correspondence should be addressed. 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.
Received March 5, 2006
Revised June 25, 2006
Accepted June 26, 2006
original article
Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?
A. C. J. van Akkooi 1, J. H. W. de Wilt 1, C. Verhoef 1, P. I. M. Schmitz 2, A. N. van Geel 1, A. M. M. Eggermont 1 *, and M. Kliffen 3
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
A. M. M. Eggermont, E-mail: a.m.m.eggermont{at}erasmusmc.nl
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