Predictors of sentinel lymph node positivity in thin melanoma using the National Cancer Database.
Adult
Age Factors
American Cancer Society
Biopsy, Needle
Databases, Factual
Female
Humans
Immunohistochemistry
Male
Melanoma
/ mortality
Middle Aged
Neoplasm Invasiveness
/ pathology
Neoplasm Staging
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Assessment
Sentinel Lymph Node
/ pathology
Sex Factors
Skin Neoplasms
/ mortality
Survival Analysis
United States
Young Adult
Melanoma, Cutaneous Malignant
Clark level
National Cancer Database
melanoma
mitotic rate
sentinel lymph node biopsy
thin
Journal
Journal of the American Academy of Dermatology
ISSN: 1097-6787
Titre abrégé: J Am Acad Dermatol
Pays: United States
ID NLM: 7907132
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
11
12
2017
revised:
26
08
2018
accepted:
29
08
2018
pubmed:
22
9
2018
medline:
6
3
2019
entrez:
22
9
2018
Statut:
ppublish
Résumé
Sentinel lymph node biopsy (SLNB) specimens are often obtained from patients for further staging after these patients have undergone melanoma excision. Limited data regarding predictors of SLNB positivity in thin melanoma are available. We sought to evaluate predictors of SLNB positivity in thin melanoma. Patients with cutaneous melanoma with a Breslow thickness ≤1.00 mm who received a SLNB were identified from the National Cancer Database between 2004 and 2014 (n = 9186). Predictors of SLNB positivity were analyzed using logistic regression. In a multivariate analysis, patients <60 years of age (P < .001) and Breslow thickness >0.8 mm (P = .03) were at increased risk for positive sentinel lymph node (SLN). Moreover, on multivariate analysis, the presence of dermal mitoses increased the odds of SLN positivity by 95% (odds ratio [OR] 1.95 [95% confidence interval {CI} 1.53-2.5], P < .001), ulceration by 63% (OR 1.63 [95% CI 1.21-2.18], P < .001), and Clark level IV to V by 48% (OR 1.48 [95% CI 1.19-1.85]). Patients without ulceration but with dermal mitoses had 92% (OR 1.92 [95% CI 1.5-2.48], P < .001) increased SLN positivity. Limited survival data are available. Younger age, a Breslow thickness >0.8 mm, the presence of dermal mitoses, ulceration, and Clark level IV to V are positive predictors of positive SLN. While the new American Joint Committee on Cancer system has removed dermal mitotic rate from staging, continued evaluation of dermal mitotic rate could be valuable for guiding surgical decision making about SLNB.
Sections du résumé
BACKGROUND
BACKGROUND
Sentinel lymph node biopsy (SLNB) specimens are often obtained from patients for further staging after these patients have undergone melanoma excision. Limited data regarding predictors of SLNB positivity in thin melanoma are available.
OBJECTIVE
OBJECTIVE
We sought to evaluate predictors of SLNB positivity in thin melanoma.
METHODS
METHODS
Patients with cutaneous melanoma with a Breslow thickness ≤1.00 mm who received a SLNB were identified from the National Cancer Database between 2004 and 2014 (n = 9186). Predictors of SLNB positivity were analyzed using logistic regression.
RESULTS
RESULTS
In a multivariate analysis, patients <60 years of age (P < .001) and Breslow thickness >0.8 mm (P = .03) were at increased risk for positive sentinel lymph node (SLN). Moreover, on multivariate analysis, the presence of dermal mitoses increased the odds of SLN positivity by 95% (odds ratio [OR] 1.95 [95% confidence interval {CI} 1.53-2.5], P < .001), ulceration by 63% (OR 1.63 [95% CI 1.21-2.18], P < .001), and Clark level IV to V by 48% (OR 1.48 [95% CI 1.19-1.85]). Patients without ulceration but with dermal mitoses had 92% (OR 1.92 [95% CI 1.5-2.48], P < .001) increased SLN positivity.
LIMITATIONS
CONCLUSIONS
Limited survival data are available.
CONCLUSIONS
CONCLUSIONS
Younger age, a Breslow thickness >0.8 mm, the presence of dermal mitoses, ulceration, and Clark level IV to V are positive predictors of positive SLN. While the new American Joint Committee on Cancer system has removed dermal mitotic rate from staging, continued evaluation of dermal mitotic rate could be valuable for guiding surgical decision making about SLNB.
Identifiants
pubmed: 30240775
pii: S0190-9622(18)32583-0
doi: 10.1016/j.jaad.2018.08.051
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
441-447Informations de copyright
Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.