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

Annals of Surgical Treatment and Research 2018년 95권 5호 p.286 ~ 296
KMID : 0371420180950050286
 ( Portinari Mattia ) - S. Anna University Hospital Department of Surgery

 ( Baldini Gabriele ) - Montreal General Hospital McGill University Health Centre Department of Anesthesia
 ( Guidoboni Massimo ) - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori Immunotherapy and Somatic Cell Therapy Unit
 ( Borghi Alessandro ) - S. Anna University Hospital Department of Medical Sciences
 ( Panareo Stefano ) - S. Anna University Hospital Department of Diagnostic Imaging
 ( Bonazza Simona ) - S. Anna University Hospital Department of Surgery
 ( Dionigi Gianlorenzo ) - University of Messina University Hospital G. Martino Department of Human Pathology
 ( Carcoforo Paolo ) - S. Anna University Hospital Department of Surgery

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.
KeyWords

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