Factors predictive of pelvic lymph node involvement and outcomes in melanoma patients with metastatic sentinel lymph node of the groin

A multicentre study

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction: The optimal extent of the groin lymph node (LN) dissection for melanoma patients with positive sentinel LN biopsy is still debated and no agreement exist on dissection of pelvic LN. This study aimed at investigating predictors of pelvic LN metastasis and prognostic significance of having metastasis in the pelvic LNs. Methods: Clinicopathologic data of 740 patients with positive groin sentinel LN who underwent ilioinguinal completion LN dissection at four Italian centre were analysed. Multivariable logistic and Cox regression analysis was used to identify independent predictors of pelvic LN metastasis and to adjust prognostic significance of pelvic LN metastasis. Results: More than a quarter (26%) of patients had positive non-SLNs after inguinal and pelvic lymphadenectomy, which were located in their pelvis in the 12% of cases. Older patients [(OR) 1.69; 95% confidence interval (CI) 1.02-2.78] having thick primary (OR 1.6; 95% CI, 1.01-2.53) and ≥ 2 positive SLNs (OR 2.5; 95% CI, 1.4-4.47) were more likely to harbour pelvic LN metastasis. Interestingly, 4% of all patients (34% of patients with positive pelvic LNs) had pelvic LN metastasis with negative inguinal LNs. Pelvic LN metastasis was independently associated with higher risk of recurrence and lower survival. 5-year disease free and overall survival was 30% and 50%, respectively, for patients with pelvic LN metastasis. Conclusions: Pelvic LNs are frequently positive after ilioinguinal lymphadenectomy and it should be considered for all patients, especially those who are older, have thick primary and ≥ 2 positive SLN. Patients with pelvic LN metastasis have worse prognosis.

Original languageEnglish
Pages (from-to)823-829
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume41
Issue number7
DOIs
Publication statusPublished - Jul 1 2015

Fingerprint

Groin
Multicenter Studies
Melanoma
Lymph Nodes
Neoplasm Metastasis
Lymph Node Excision
Confidence Intervals
Sentinel Lymph Node
Sentinel Lymph Node Biopsy
Pelvis
Disease-Free Survival
Logistic Models
Regression Analysis
Recurrence

Keywords

  • Deep disease
  • Melanoma
  • Node metastasis
  • Sentinel lymph node

ASJC Scopus subject areas

  • Oncology
  • Surgery
  • Medicine(all)

Cite this

@article{241f6f4a98b34e7a8611bab19caea14d,
title = "Factors predictive of pelvic lymph node involvement and outcomes in melanoma patients with metastatic sentinel lymph node of the groin: A multicentre study",
abstract = "Introduction: The optimal extent of the groin lymph node (LN) dissection for melanoma patients with positive sentinel LN biopsy is still debated and no agreement exist on dissection of pelvic LN. This study aimed at investigating predictors of pelvic LN metastasis and prognostic significance of having metastasis in the pelvic LNs. Methods: Clinicopathologic data of 740 patients with positive groin sentinel LN who underwent ilioinguinal completion LN dissection at four Italian centre were analysed. Multivariable logistic and Cox regression analysis was used to identify independent predictors of pelvic LN metastasis and to adjust prognostic significance of pelvic LN metastasis. Results: More than a quarter (26{\%}) of patients had positive non-SLNs after inguinal and pelvic lymphadenectomy, which were located in their pelvis in the 12{\%} of cases. Older patients [(OR) 1.69; 95{\%} confidence interval (CI) 1.02-2.78] having thick primary (OR 1.6; 95{\%} CI, 1.01-2.53) and ≥ 2 positive SLNs (OR 2.5; 95{\%} CI, 1.4-4.47) were more likely to harbour pelvic LN metastasis. Interestingly, 4{\%} of all patients (34{\%} of patients with positive pelvic LNs) had pelvic LN metastasis with negative inguinal LNs. Pelvic LN metastasis was independently associated with higher risk of recurrence and lower survival. 5-year disease free and overall survival was 30{\%} and 50{\%}, respectively, for patients with pelvic LN metastasis. Conclusions: Pelvic LNs are frequently positive after ilioinguinal lymphadenectomy and it should be considered for all patients, especially those who are older, have thick primary and ≥ 2 positive SLN. Patients with pelvic LN metastasis have worse prognosis.",
keywords = "Deep disease, Melanoma, Node metastasis, Sentinel lymph node",
author = "N. Mozzillo and S. Pasquali and M. Santinami and A. Testori and {Di Marzo}, M. and A. Crispo and R. Patuzzo and F. Verrecchia and G. Botti and M. Montella and Rossi, {C. R.} and C. Carac{\`o}",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.ejso.2015.02.005",
language = "English",
volume = "41",
pages = "823--829",
journal = "European Journal of Surgical Oncology",
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publisher = "W.B. Saunders Ltd",
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}

TY - JOUR

T1 - Factors predictive of pelvic lymph node involvement and outcomes in melanoma patients with metastatic sentinel lymph node of the groin

T2 - A multicentre study

AU - Mozzillo, N.

AU - Pasquali, S.

AU - Santinami, M.

AU - Testori, A.

AU - Di Marzo, M.

AU - Crispo, A.

AU - Patuzzo, R.

AU - Verrecchia, F.

AU - Botti, G.

AU - Montella, M.

AU - Rossi, C. R.

AU - Caracò, C.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Introduction: The optimal extent of the groin lymph node (LN) dissection for melanoma patients with positive sentinel LN biopsy is still debated and no agreement exist on dissection of pelvic LN. This study aimed at investigating predictors of pelvic LN metastasis and prognostic significance of having metastasis in the pelvic LNs. Methods: Clinicopathologic data of 740 patients with positive groin sentinel LN who underwent ilioinguinal completion LN dissection at four Italian centre were analysed. Multivariable logistic and Cox regression analysis was used to identify independent predictors of pelvic LN metastasis and to adjust prognostic significance of pelvic LN metastasis. Results: More than a quarter (26%) of patients had positive non-SLNs after inguinal and pelvic lymphadenectomy, which were located in their pelvis in the 12% of cases. Older patients [(OR) 1.69; 95% confidence interval (CI) 1.02-2.78] having thick primary (OR 1.6; 95% CI, 1.01-2.53) and ≥ 2 positive SLNs (OR 2.5; 95% CI, 1.4-4.47) were more likely to harbour pelvic LN metastasis. Interestingly, 4% of all patients (34% of patients with positive pelvic LNs) had pelvic LN metastasis with negative inguinal LNs. Pelvic LN metastasis was independently associated with higher risk of recurrence and lower survival. 5-year disease free and overall survival was 30% and 50%, respectively, for patients with pelvic LN metastasis. Conclusions: Pelvic LNs are frequently positive after ilioinguinal lymphadenectomy and it should be considered for all patients, especially those who are older, have thick primary and ≥ 2 positive SLN. Patients with pelvic LN metastasis have worse prognosis.

AB - Introduction: The optimal extent of the groin lymph node (LN) dissection for melanoma patients with positive sentinel LN biopsy is still debated and no agreement exist on dissection of pelvic LN. This study aimed at investigating predictors of pelvic LN metastasis and prognostic significance of having metastasis in the pelvic LNs. Methods: Clinicopathologic data of 740 patients with positive groin sentinel LN who underwent ilioinguinal completion LN dissection at four Italian centre were analysed. Multivariable logistic and Cox regression analysis was used to identify independent predictors of pelvic LN metastasis and to adjust prognostic significance of pelvic LN metastasis. Results: More than a quarter (26%) of patients had positive non-SLNs after inguinal and pelvic lymphadenectomy, which were located in their pelvis in the 12% of cases. Older patients [(OR) 1.69; 95% confidence interval (CI) 1.02-2.78] having thick primary (OR 1.6; 95% CI, 1.01-2.53) and ≥ 2 positive SLNs (OR 2.5; 95% CI, 1.4-4.47) were more likely to harbour pelvic LN metastasis. Interestingly, 4% of all patients (34% of patients with positive pelvic LNs) had pelvic LN metastasis with negative inguinal LNs. Pelvic LN metastasis was independently associated with higher risk of recurrence and lower survival. 5-year disease free and overall survival was 30% and 50%, respectively, for patients with pelvic LN metastasis. Conclusions: Pelvic LNs are frequently positive after ilioinguinal lymphadenectomy and it should be considered for all patients, especially those who are older, have thick primary and ≥ 2 positive SLN. Patients with pelvic LN metastasis have worse prognosis.

KW - Deep disease

KW - Melanoma

KW - Node metastasis

KW - Sentinel lymph node

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U2 - 10.1016/j.ejso.2015.02.005

DO - 10.1016/j.ejso.2015.02.005

M3 - Article

VL - 41

SP - 823

EP - 829

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 7

ER -