TY - JOUR
T1 - Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram.
AU - Maurichi, Andrea
AU - Miceli, Rosalba
AU - Eriksson, Hanna
AU - Newton-Bishop, Julia
AU - Nsengimana, Jérémie
AU - Chan, May
AU - Hayes, Andrew J.
AU - Heelan, Kara
AU - Adams, David
AU - Patuzzo, Roberto
AU - Barretta, Francesco
AU - Gallino, Gianfranco
AU - Harwood, Catherine
AU - Bergamaschi, Daniele
AU - Bennett, Dorothy
AU - Lasithiotakis, Konstantinos
AU - Ghiorzo, Paola
AU - Dalmasso, Bruna
AU - Manganoni, Ausilia
AU - Consoli, Francesca
AU - Mattavelli, Ilaria
AU - Barbieri, Consuelo
AU - Leva, Andrea
AU - Cortinovis, Umberto
AU - Espeli, Vittoria
AU - Mangas, Cristina
AU - Quaglino, Pietro
AU - Ribero, Simone
AU - Broganelli, Paolo
AU - Pellacani, Giovanni
AU - Longo, Caterina
AU - Del Forno, Corrado
AU - Borgognoni, Lorenzo
AU - Sestini, Serena
AU - Pimpinelli, Nicola
AU - Fortunato, Sara
AU - Chiarugi, Alessandra
AU - Nardini, Paolo
AU - Morittu, Elena
AU - Florita, Antonio
AU - Cossa, Mara
AU - Valeri, Barbara
AU - Milione, Massimo
AU - Pruneri, Giancarlo
AU - Zoras, Odysseas
AU - Anichini, Andrea
AU - Mortarini, Roberta
AU - Santinami, Mario
PY - 2020/5/1
Y1 - 2020/5/1
N2 - PURPOSE: Thin melanomas (T1; ≤ 1 mm) constitute 70SNB) is an important prognostic factor for T1 melanoma. However, current melanoma guidelines do not provide clear indications on when to perform SNB in T1 disease and stress an individualized approach to SNB that considers all clinicopathologic risk factors. We aimed to identify determinants of sentinel node (SN) status for incorporation into an externally validated nomogram to better select patients with T1 disease for SNB. PATIENTS AND METHODS: The development cohort comprised 3,666 patients with T1 disease consecutively treated at the Istituto Nazionale Tumori (Milan, Italy) between 2001 and 2018; 4,227 patients with T1 disease treated at 13 other European centers over the same period formed the validation cohort. A random forest procedure was applied to the development data set to select characteristics associated with SN status for inclusion in a multiple binary logistic model from which a nomogram was elaborated. Decision curve analyses assessed the clinical utility of the nomogram. RESULTS: Of patients in the development cohort, 1,635 underwent SNB; 108 patients (6.6 were SN positive. By univariable analysis, age, growth phase, Breslow thickness, ulceration, mitotic rate, regression, and lymphovascular invasion were significantly associated with SN status. The random forest procedure selected 6 variables (not growth phase) for inclusion in the logistic model and nomogram. The nomogram proved well calibrated and had good discriminative ability in both cohorts. Decision curve analyses revealed the superior net benefit of the nomogram compared with each individual variable included in it as well as with variables suggested by current guidelines. CONCLUSION: We propose the nomogram as a decision aid in all patients with T1 melanoma being considered for SNB.
AB - PURPOSE: Thin melanomas (T1; ≤ 1 mm) constitute 70SNB) is an important prognostic factor for T1 melanoma. However, current melanoma guidelines do not provide clear indications on when to perform SNB in T1 disease and stress an individualized approach to SNB that considers all clinicopathologic risk factors. We aimed to identify determinants of sentinel node (SN) status for incorporation into an externally validated nomogram to better select patients with T1 disease for SNB. PATIENTS AND METHODS: The development cohort comprised 3,666 patients with T1 disease consecutively treated at the Istituto Nazionale Tumori (Milan, Italy) between 2001 and 2018; 4,227 patients with T1 disease treated at 13 other European centers over the same period formed the validation cohort. A random forest procedure was applied to the development data set to select characteristics associated with SN status for inclusion in a multiple binary logistic model from which a nomogram was elaborated. Decision curve analyses assessed the clinical utility of the nomogram. RESULTS: Of patients in the development cohort, 1,635 underwent SNB; 108 patients (6.6 were SN positive. By univariable analysis, age, growth phase, Breslow thickness, ulceration, mitotic rate, regression, and lymphovascular invasion were significantly associated with SN status. The random forest procedure selected 6 variables (not growth phase) for inclusion in the logistic model and nomogram. The nomogram proved well calibrated and had good discriminative ability in both cohorts. Decision curve analyses revealed the superior net benefit of the nomogram compared with each individual variable included in it as well as with variables suggested by current guidelines. CONCLUSION: We propose the nomogram as a decision aid in all patients with T1 melanoma being considered for SNB.
M3 - Article
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
SN - 0732-183X
IS - 14
ER -