@article{54f35aaa6b62434ea0ab7369491f9fa6,
title = "Factors affecting sentinel node metastasis in thin (T1) cutaneous melanomas: Development and external validation of a predictive nomogram",
abstract = "PURPOSE Thin melanomas (T1; # 1 mm) constitute 70% of newly diagnosed cutaneous melanomas. Regional node metastasis determined by sentinel node biopsy (SNB) 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. {\textcopyright} 2020 by American Society of Clinical Oncology",
keywords = "adult, age, aged, Article, Breslow thickness, cancer diagnosis, cohort analysis, controlled study, cutaneous melanoma, female, growth curve, human, lymph node dissection, lymph vessel metastasis, major clinical study, male, mitosis rate, nomogram, patient selection, practice guideline, priority journal, random forest, sentinel lymph node metastasis, ulcer",
author = "A. Maurichi and R. Miceli and H. Eriksson and J. Newton-Bishop and J. Nsengimana and M. Chan and A.J. Hayes and K. Heelan and D. Adams and R. Patuzzo and F. Barretta and G. Gallino and C. Harwood and D. Bergamaschi and D. Bennett and K. Lasithiotakis and P. Ghiorzo and B. Dalmasso and A. Manganoni and F. Consoli and I. Mattavelli and C. Barbieri and A. Leva and U. Cortinovis and V. Espeli and C. Mangas and P. Quaglino and S. Ribero and P. Broganelli and G. Pellacani and C. Longo and {Del Forno}, C. and L. Borgognoni and S. Sestini and N. Pimpinelli and S. Fortunato and A. Chiarugi and P. Nardini and E. Morittu and A. Florita and M. Cossa and B. Valeri and M. Milione and G. Pruneri and O. Zoras and A. Anichini and R. Mortarini and M. Santinami",
note = "Cited By :8 Export Date: 26 February 2021 CODEN: JCOND Correspondence Address: Maurichi, A.; Melanoma and Sarcoma Unit, Via Venezian 1, Italy; email: andrea.maurichi@istitutotumori.mi.it Funding details: National Institutes of Health, NIH Funding details: Cancer Research UK, CRUK, CA83115 Funding text 1: Supported in part by Grants No. C588/A19167, C8216/A6129, and C588/A10721 from Cancer Research UK and by Grant No. CA83115 from the US National Institutes of Health. 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year = "2020",
doi = "10.1200/JCO.19.01902",
language = "English",
volume = "38",
pages = "1591--1601",
journal = "J. Clin. Oncol.",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "14",
}