Ann Surg Treat Res.  2018 Nov;95(5):286-296. 10.4174/astr.2018.95.5.286.

The long-term prognostic impact of sentinel lymph node biopsy in patients with primary cutaneous melanoma: a prospective study with 10-year follow-up

• Portinari
• Baldini G
• Guidoboni
• Borghi A
• Panareo S
• Bonazza S
• Dionigi G
• Carcoforo

• KMID: 2422938
• DOI: http://doi.org/10.4174/astr.2018.95.5.286

Abstract

PURPOSE
Sentinel lymph node (SLN) biopsy (SLNB) is widely accepted for staging of melanoma patients. It has been shown that clinico-pathological features such as Breslow thickness, ulceration, age, and sex are better predictors of relapse and survival than SLN status alone. The aims of this study were to evaluate the long-term (10-year) prognostic impact of SLNB and to determine predictive factors associated with SLN metastasis, relapse, and melanoma specific mortality (MSM).
METHODS
This was a prospective observational study on 289 consecutive patients with primary cutaneous melanoma who underwent SLNB from January 2000 to December 2007, and followed until January 2014, at an Italian academic hospital.
RESULTS
SLN was positive in 64 patients (22.1%). The median follow-up was 116 months (79-147 months). Ten-year disease-free survival and melanoma specific survival were poor in patients with positive SLN (58.7% and 66.4%, respectively). Only the increasing Breslow thickness resulted independently associated to an increased risk of SLN metastasis. Cox regression analysis showed that a Breslow thickness >2 mm was an independent predictor of relapse, and male sex and Breslow thickness >2 mm was a predictor of MSM. At 10 years, SLN metastasis was not significantly associated to either relapse or MSM.
CONCLUSION
After the fifth year of follow-up, SLN metastasis is not an independent predictive factor of relapse or mortality which are mainly influenced by the characteristics of the primary tumor and of the patient. Patients with a Breslow thickness >2 mm regardless of the SLN status should be considered at high risk for 10-year relapse and mortality.

Keyword

Melanoma; Sentinel lymph node biopsy; Prospective studies; Survival analysis; Risk factors

MeSH Terms

Biopsy
Disease-Free Survival
Follow-Up Studies*
Humans
Lymph Nodes
Male
Melanoma*
Mortality
Neoplasm Metastasis
Observational Study
Prospective Studies*
Recurrence
Risk Factors
Sentinel Lymph Node Biopsy*
Survival Analysis
Ulcer

Figure

• 

  Fig. 1 Disease free survival. The panels show the disease free survival of melanoma patients according to sex (A), age (B), Breslow thickness (C), ulceration (D), sentinel lymph node status (E), and American Joint Committee on Cancer (AJCC) stratification (F).

• 

  Fig. 2 Melanoma specific survival. The panels show the melanoma specific survival of melanoma patients according to sex (A), age (B), Breslow thickness (C), ulceration (D), sentinel lymph node status (E), and American Joint Committee on Cancer (AJCC) stratification (F).

• 

  Fig. 3 Subgroup survival analysis. The panels show, among patients with positive sentinel lymph node, the survival analysis comparing patients who underwent radical regional lymphadenectomy after sentinel lymph node biopsy (n = 48) and patients in which the procedure was not performed (n = 16).

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