Clinical and histopathological risk factors to predict sentinel lymph node positivity, disease-free and overall survival in clinical stages I–II AJCC skin melanoma: Outcome analysis from a single-institution prospectively collected database
Mandalà M et al. - In a trial to investigate if the tumour infiltrating lymphocytes (TILs) are able to predict sentinel lymph node (SLN) positivity, disease-free survival (DFS), and overall survival (OS) in clinical stages I-II AJCC primary cutaneous melanoma (PCM), this study demonstrates that absence of TILs predicts SLN metastasis, in multivariate analysis the SLN positivity predicts DFS and OS. Methods- The study included consecutive pts with PCM, all diagnosed, treated, and followed up prospectively.
- Logistic regression was used to investigate the association between DFS, OS, SLN positivity, and Breslow thickness, Clark level, TIL, ulceration, lesion site, gender, regression and age.
Results- 1251 consecutive pts with PCM were evaluated.
- Median age was 51 with 32.2% (n = 393) of them older than 60; 44.8% of them were males.
- Of the whole series, 404 pts with primary vertical growth phase (VGP) melanoma and no clinical evidence of metastatic disease underwent SLN biopsy.
- Of these, 74 (18.8%) had a positive SLN.
- In multivariate analysis, primary melanoma on the extremities vs that on the axial locations (truncal and head/neck) and TILs (TILs vs no TILs) were predictive for lower probability of SLN involvement, while thickness (>4 mm vs 0–1 mm) was predictive for higher risk of SLN positivity.
- A multivariate stepwise analysis confirmed these results.
- The histological status of the SLN was the most significant predictor of DFS and OS.
- Pts with a negative SLN had a 5-yr DFS of 75.9%, compared with 35.2% in pts with a positive SLN and a 5-yr OS of 88.7% vs 42.9%, respectively.
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