Skin Cancer Department, AC Camargo Cancer Center, São Paulo, SP, Brazil.
Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Ann Surg Oncol. 2019 Feb;26(2):395-405. doi: 10.1245/s10434-018-7038-9. Epub 2018 Nov 19.
Non-sentinel node (NSN) positivity impacts the prognosis of melanoma patients; however, the benefits of completion lymph node dissection in patients with positive sentinel nodes (SNs) are limited.
We aimed to present a predictive nomogram for NSN positivity in melanoma patients with a positive SN biopsy.
This retrospective analysis from patients who underwent SN biopsy in a Brazilian institution from 2000 to 2015 was used for the construction and internal validation of the nomogram. This nomogram was then externally validated in a cohort of Dutch patients.
The Brazilian cohort comprised 1213 patients, with a mean follow-up of 5.11 years. Breslow thickness (odds ratio [OR] 1.170, 95% confidence interval [CI] 1.043-1.314]; p = 0.008), number of positive SNs (OR 1.092, 95% CI 1.034-1.153; p = 0.001), and largest diameter of the metastatic deposit (OR 3.217, 95% CI 1.551-6.674; p = 0.002) were statistically significant for NSN positivity. Internal validation was performed using a bootstrapping technique. A good performance was observed (Brier score 0.097) and an excellent power of discrimination was achieved (area under the curve [AUC] 0.822). The nomogram was then applied to the Dutch cohort, and its overall performance (Brier score 0.085), calibration (Hosmer-Lemeshow goodness-of-fit test; p = 0.198), and discriminatory power (AUC 0.752, 95% CI 0.615-0.890) were all adequate.
We presented a nomogram for assessing NSN probability that should not only be used for surgical considerations but also for risk stratification and clinical decisions. Internal validation has shown that this is an adequate model, while external validation increases the model's reliability and suggests that it can be globally incorporated.
非前哨淋巴结（NSN）阳性会影响黑色素瘤患者的预后；然而，在前哨淋巴结（SN）阳性的患者中进行淋巴结清扫术的获益是有限的。
我们旨在为 SN 活检阳性的黑色素瘤患者提出一个预测 NSN 阳性的预测列线图。
本研究回顾性分析了 2000 年至 2015 年在巴西一家机构接受 SN 活检的患者，该研究用于构建和验证列线图。然后，在荷兰患者队列中对该列线图进行了外部验证。
巴西队列包括 1213 例患者，平均随访 5.11 年。Breslow 厚度（比值比 [OR] 1.170，95%置信区间 [CI] 1.043-1.314；p=0.008）、阳性 SN 数量（OR 1.092，95%CI 1.034-1.153；p=0.001）和最大转移灶直径（OR 3.217，95%CI 1.551-6.674；p=0.002）对 NSN 阳性具有统计学意义。使用 bootstrap 技术进行了内部验证。观察到良好的性能（Brier 评分 0.097）和出色的区分能力（曲线下面积 [AUC] 0.822）。然后将该列线图应用于荷兰队列，其整体性能（Brier 评分 0.085）、校准（Hosmer-Lemeshow 拟合优度检验；p=0.198）和区分能力（AUC 0.752，95%CI 0.615-0.890）均令人满意。
我们提出了一种用于评估 NSN 概率的列线图，不仅应用于手术考虑，还应用于风险分层和临床决策。内部验证表明这是一个合适的模型，而外部验证则提高了模型的可靠性，并表明它可以在全球范围内使用。
