More sentinel lymph node biopsies for thin melanomas after transition to AJCC 8th edition do not increase positivity rate: A Danish population-based study of 7148 patients.
cancer staging
lymph node metastasis
mitosis
ulceration
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
revised:
11
10
2021
received:
26
07
2021
accepted:
15
10
2021
pubmed:
22
10
2021
medline:
5
2
2022
entrez:
21
10
2021
Statut:
ppublish
Résumé
We evaluated the outcome of sentinel lymph node biopsies (SLNB) in patients with thin melanoma before and after the implementation of AJCC 8th edition (AJCC8) and identified predictors of positive sentinel lymph nodes (+SLN). Patients diagnosed with T1 melanomas (Breslow thickness ≤1 mm) during 2016-2017 as per AJCC 7th edition (AJCC7) (n = 3414) and 2018-2019 as per AJCC8 (n = 3734) were identified in the Danish Melanoma Database. More SLNBs were performed in the AJCC8 cohort compared to the AJCC7 (22.2% vs. 16.2%, p < 0.001), with no significant difference in +SLN rates (4.7% vs. 6.7%, p = 0.118). In the AJCC7 + SLN subgroup, no melanomas were ulcerated, 94.6% had mitotic rate (MR) ≥ 1, 67.6% were ≥0.8 mm and 32.4% would be T1a according to AJCC8. In the AJCC8 + SLN subgroup, 10.3% were ulcerated, 74.4% had MR≥ 1, 97.4% were ≥0.8 mm and 23.1% would be T1a according to AJCC7. On multivariable analysis younger age and MR ≥ 1 were significant predictors of +SLN. More SLNBs were performed in T1 melanomas after transition to AJCC8 without an increase in +SLN rate. None of the AJCC8 T1b criteria were significant predictors of +SLN. We suggest that mitosis and younger age should be considered as indications for SLNB in thin melanoma.
Sections du résumé
BACKGROUND
BACKGROUND
We evaluated the outcome of sentinel lymph node biopsies (SLNB) in patients with thin melanoma before and after the implementation of AJCC 8th edition (AJCC8) and identified predictors of positive sentinel lymph nodes (+SLN).
METHODS
METHODS
Patients diagnosed with T1 melanomas (Breslow thickness ≤1 mm) during 2016-2017 as per AJCC 7th edition (AJCC7) (n = 3414) and 2018-2019 as per AJCC8 (n = 3734) were identified in the Danish Melanoma Database.
RESULTS
RESULTS
More SLNBs were performed in the AJCC8 cohort compared to the AJCC7 (22.2% vs. 16.2%, p < 0.001), with no significant difference in +SLN rates (4.7% vs. 6.7%, p = 0.118). In the AJCC7 + SLN subgroup, no melanomas were ulcerated, 94.6% had mitotic rate (MR) ≥ 1, 67.6% were ≥0.8 mm and 32.4% would be T1a according to AJCC8. In the AJCC8 + SLN subgroup, 10.3% were ulcerated, 74.4% had MR≥ 1, 97.4% were ≥0.8 mm and 23.1% would be T1a according to AJCC7. On multivariable analysis younger age and MR ≥ 1 were significant predictors of +SLN.
CONCLUSION
CONCLUSIONS
More SLNBs were performed in T1 melanomas after transition to AJCC8 without an increase in +SLN rate. None of the AJCC8 T1b criteria were significant predictors of +SLN. We suggest that mitosis and younger age should be considered as indications for SLNB in thin melanoma.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
498-508Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472-492.
Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242(3):302-313.
Serra-Arbeloa P, Rabines-Juárez ÁO, Álvarez-Ruiz MS, Guillén-Grima F. Sentinel node biopsy in patients with primary cutaneous melanoma of any thickness: a cost-effectiveness analysis. Surg Oncol. 2016;25(3):205-211.
Agnese DM, Abdessalam SF, Burak WE, Magro CM, Pozderac RV, Walker MJ. Cost-effectiveness of sentinel lymph node biopsy in thin melanomas. Surgery. 2003;134(4):542-547.
Helvind NM, Hölmich LR, Smith S, et al. Incidence of in situ and invasive melanoma in Denmark from 1985 through 2012: a national database study of 24 059 melanoma cases. JAMA Dermatol. 2015; 151(10):1087-1095.
The Danish Melanoma Group. Dansk Melanom Database årsrapport 2020 [The Danish Melanoma Database annual quality report 2020]. 2021. https://www.sundhed.dk/content/cms/30/57130_dmd_aarsrapport_2020_anonym.pdf
Pasquali S, Hadjinicolaou A, Sileni V, et al. Systemic treatments for metastatic cutaneous melanoma (Review). Cochrane Database Syst Rev. 2018;1(2):CD011123.
Wong SL, Faries MB, Kennedy EB, et al. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline update. Ann Surg Oncol. 2018;25(2):356-377.
Haldrup M, Stolle LB, Rosenkrantz Hölmich L, Chakera A. Sentinel node-positivt melanom [Sentinel node positive melanoma]. J Danish Med Assoc. 2018;180:V03180192.
Michielin O, Van Akkooi ACJ, Ascierto PA, Dummer R, Keilholz U. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(12):1884-1901.
Swetter SM, Tsao H, Bichakjian CK, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2019;80(1):208-250.
The Danish Health Authority Pakkeforløb for modermaerkekraeft i huden [Danish Cancer Patient Pathway for melanoma patients]. 2020. https://www.sst.dk/-/media/Udgivelser//Modermaerkekraeft/Pakkeforloeb-for-modermaerkekraeft-i-huden.ashx?la=da%26hash=87D5DB0DE5A4D72EBF1CA278EE8802E16FCB581D
Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211-2222.
Egger ME, Stevenson M, Bhutiani N, et al. Should sentinel lymph node biopsy be performed for all T1b melanomas in the new 8 th Edition American Joint Committee on Cancer Staging System? J Am Coll Surg. 2019;228(4):466-472.
Friedman C, Lyon M, Torphy RJ, et al. A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making. J Surg Oncol. 2019;120(7):1276-1283.
Isaksson K, Nielsen K, Mikiver R, et al. Sentinel lymph node biopsy in patients with thin melanomas: frequency and predictors of metastasis based on analysis of two large international cohorts. J Surg Oncol. 2018;118(4):599-605.
Wheless L, Isom CA, Hooks MA, Kauffmann RM. Mitotic rate is associated with positive lymph nodes in patients with thin melanomas. J Am Acad Dermatol. 2018;78(5):935-941.
Lo SN, Ma J, Scolyer RA, et al. Improved risk prediction calculator for sentinel node positivity in patients with melanoma: the Melanoma Institute Australia Nomogram. J Clin Oncol. 2020;38(24):2719-2727.
Maurichi A, Miceli R, Eriksson H, et al. Factors affecting sentinel node metastasis in thin (T1) cutaneous melanomas: development and external validation of a predictive nomogram. J Clin Oncol. 2020;38(14):1591-1601.
Joyce KM, McInerney NM, Joyce CW, et al. A review of sentinel lymph node biopsy for thin melanoma. Ir J Med Sci. 2015;184(1):119-123.
Cordeiro E, Gervais MK, Shah PS, Look Hong NJ, Wright FC. Sentinel lymph node biopsy in thin cutaneous melanoma: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23(13):4178-4188.
Hölmich LR, Klausen S, Spaun E, et al. The Danish melanoma database. Clin Epidemiol. 2016;8:543-548.
Dummer R, Hauschild A, Santinami M, et al. Five-year analysis of adjuvant dabrafenib plus trametinib in stage III melanoma. N Engl J Med. 2020;383(12):1139-1148.
Ascierto PA, Del Vecchio M, Mandalá M, et al. Adjuvant nivolumab versus ipilimumab in resected stage IIIB-C and stage IV melanoma (CheckMate 238): 4-year results from a multicentre, double-blind, randomised, controlled, phase 3 trial. Lancet Oncol. 2020;21(11):1465-1477.
Valsecchi ME, Silbermins D, De Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. J Clin Oncol. 2011;29(11):1479-1487.
Lee DY, Huynh KT, Teng A, et al. Predictors and survival impact of false-negative sentinel nodes in melanoma. Ann Surg Oncol. 2016;23(3):1012-1018.
Lo SN, Scolyer RA, Thompson JF. Long-term survival of patients with thin (T1) cutaneous melanomas: a Breslow thickness cut point of 0.8 mm separates higher-risk and lower-risk tumors. Ann Surg Oncol. 2018;25(4):894-902.
Antonialli AZ, Bertolli E, de Macedo MP, Pinto C, Calsavara VF, Neto J. How does the mitotic index impact patients with T1 melanoma? Comparison between the 7th and 8th edition of the American Joint Committee on Cancer melanoma staging system. An Bras Dermatol. 2020;95(6):691-695.
Kocsis A, Karsko L, Kurgyis Z, et al. Is it necessary to perform sentinel lymph node biopsy in thin melanoma? A retrospective single center analysis. Pathol Oncol Res. 2020;26(3):1861-1868.
Piazzalunga D, Ceresoli M, Allievi N, et al. Can sentinel node biopsy be safely omitted in thin melanoma? Risk factor analysis of 1272 multicenter prospective cases. Eur J Surg Oncol. 2019;45(5):820-824.
Conic RRZ, Ko J, Damiani G, et al. Predictors of sentinel lymph node positivity in thin melanoma using the National Cancer Database. J Am Acad Dermatol. 2019;80(2):441-447.
Sinnamon AJ, Neuwirth MG, Yalamanchi P, et al. Association between patient age and lymph node positivity in thin melanoma. JAMA Dermatol. 2017;153(9):866-873.
Han D, Zager JS, Shyr Y, et al. Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. J Clin Oncol. 2013;31(35):4387-4393.
Murali R, Haydu LE, Quinn MJ, et al. Sentinel lymph node biopsy in patients with thin primary cutaneous melanoma. Ann Surg. 2012;255(1):128-133.
Kirkland EB, Zitelli JA. Mitotic rate for thin melanomas: should a single mitotic figure warrant a sentinel lymph node biopsy? Dermatologic Surg. 2014;40(9):937-945.
Wat H, Senthilselvan A, Salopek TG. A retrospective, multicenter analysis of the predictive value of mitotic rate for sentinel lymph node (SLN) positivity in thin melanomas. J Am Acad Dermatol. 2016;74(1):94-101.
Thompson JF, Soong SJ, Balch CM, et al. Prognostic significance of mitotic rate in localized primary cutaneous melanoma: An analysis of patients in the multi-institutional American Joint Committee on Cancer Melanoma Staging Database. J Clin Oncol. 2011;29(16):2199-2205.
Gerami P, Cook RW, Wilkinson J, et al. Development of a prognostic genetic signature to predict the metastatic risk associated with cutaneous melanoma. Clin Cancer Res. 2015;21(1):175-183.
Eisenstein A, Gonzalez EC, Raghunathan R, et al. Emerging biomarkers in cutaneous melanoma. Mol Diagnosis Ther. 2018;22(2):203-218.
Bellomo D, Arias-Mejias SM, Ramana C, et al. Model combining tumor molecular and clinicopathologic risk factors predicts sentinel lymph node metastasis in primary cutaneous melanoma. JCO Precis Oncol. 2020;4:319-334.
Wong SL, Kattan MW, McMasters KM, Coit DG. A nomogram that predicts the presence of sentinel node metastasis in melanoma with better discrimination than the American Joint Committee on Cancer Staging System. Ann Surg Oncol. 2005;12(4):282-288.
El Sharouni MA, Varey AHR, Witkamp AJ, et al. Predicting sentinel node positivity in patients with melanoma: external validation of a risk-prediction calculator (the Melanoma Institute Australia nomogram) using a large European population-based patient cohort*. Br J Dermatol. 2021;185(2):412-418.