Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl Neuberg Strasse 1, D-30625 Hannover, Germany.
Center for Dermatooncology, Department of Dermatology, Eberhard-Karls-University of Tübingen, Tübingen, Germany.
Eur J Cancer. 2019 Dec;123:83-91. doi: 10.1016/j.ejca.2019.07.004. Epub 2019 Oct 31.
The tumor burden within the sentinel lymph node (SLN) is not included in the 8th edition of the American Joint Committee of Cancer (AJCC) melanoma classification. Therefore, we analysed the prognostic relevance of the SLN tumor burden in the stage III subgroups.
A total of 736 patients with melanoma with positive SLN and long-term follow-up (mean, 64.4 months; median, 59.0 months) were assessed. SLN tumor burden was evaluated by the maximum diameter of the largest deposit in all patients.
By univariate Kaplan-Meier analyses, melanoma-specific survival (MSS) of patients in stage IIIA, IIIB and IIIC and lower sentinel tumor burden (cut-offs ≤0.5 mm and ≤1 mm) was significantly better than that in patients with higher sentinel tumor load (>0.5 mm and >1 mm). By multivariate analysis using the Cox model, the maximum diameter of the largest deposit (cut-off ≤0.5 mm versus >0.5 mm and cut-off ≤1 mm as continuous variables) represented an independent prognostic parameter for MSS in stage III patients. Cut-off of 0.5 mm showed a slightly higher area under the receiver operating characteristic curve (AUC = 0.617) when than the cut-off of 1 mm (AUC = 0.599).
The prognosis of patients with stage III melanoma can be determined more precisely if the SLN tumor burden is considered, also within the existing AJCC subgroups. Thus, this parameter should be included in future classifications, and our study provides benchmarks in estimating prognosis and counselling patients with melanoma with positive sentinel nodes beyond the 8th AJCC Cancer Staging Manual. The optimal cut-off remains for SLN tumor burden remains to be determined, but our results suggest that a cut-off lower than 1 mm is preferable.
美国癌症联合委员会（AJCC）第 8 版黑色素瘤分类不包括前哨淋巴结（SLN）内的肿瘤负担。因此，我们分析了 SLN 肿瘤负担在 III 期亚组中的预后相关性。
共评估了 736 例 SLN 阳性且长期随访（平均 64.4 个月；中位数 59.0 个月）的黑色素瘤患者。所有患者的 SLN 肿瘤负担均通过最大沉积直径来评估。
通过单变量 Kaplan-Meier 分析，SLN 肿瘤负荷较低（截断值≤0.5mm 和≤1mm）的 IIIA、IIIB 和 IIIC 期患者的黑色素瘤特异性生存率（MSS）明显优于 SLN 肿瘤负荷较高的患者（>0.5mm 和>1mm）。通过 Cox 模型多变量分析，最大沉积直径（截断值≤0.5mm 与>0.5mm 和截断值≤1mm 作为连续变量）是 III 期患者 MSS 的独立预后参数。当截断值为 0.5mm 时，受试者工作特征曲线下面积（AUC=0.617）略高于截断值为 1mm 时（AUC=0.599）。
如果考虑 SLN 肿瘤负担，也可以在现有的 AJCC 亚组中更准确地确定 III 期黑色素瘤患者的预后。因此，该参数应包含在未来的分类中，我们的研究为 8 版 AJCC 癌症分期手册之外的 SLN 阳性黑色素瘤患者的预后评估和咨询提供了基准。SLN 肿瘤负担的最佳截断值仍有待确定，但我们的结果表明，截断值低于 1mm 更为理想。
