Sentinel Node Status is the Most Important Prognostic Information for Clinical Stage IIB and IIC Melanoma Patients
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ORIGINAL ARTICLE – MELANOMA
Sentinel Node Status is the Most Important Prognostic Information for Clinical Stage IIB and IIC Melanoma Patients Isabela Bartelli Fonseca, MD1, Marcus Vitor Nunes Lindote, MD1, Marcus Rodrigo Monteiro, MD1, Eduardo Doria Filho, MD2, Clovis Antonio Lopes Pinto, MD, PhD3, Andrea Schiavinato Jafelicci, MD4, Matheus de Melo Loˆbo, MD4, Vinicius Fernando Calsavara, PhD5, Eduardo Bertolli, MD, PhD4, and Joa˜o Pedreira Duprat Neto, MD, PhD4 1
Surgical Oncology Residence Program, A. C. Camargo Cancer Center, Sa˜o Paulo, SP, Brazil; 2Department of Surgical Oncology, Clı´nica AMO, Salvador, BA, Brazil; 3Department of Pathology, A. C. Camargo Cancer Center, Sa˜o Paulo, SP, Brazil; 4Skin Cancer Department, A. C. Camargo Cancer Center, Sa˜o Paulo, SP, Brazil; 5Department of Epidemiology and Statistics, A. C. Camargo Cancer Center, Sa˜o Paulo, SP, Brazil
ABSTRACT Background. Sentinel node biopsy (SNB) for melanoma patients has been questioned. We aimed to study high-risk stage II melanoma patients who underwent SNB to determine what the prognostic factors regarding recurrence and mortality were, and evaluate how relevant SNB status is in this scenario. Methods. This was a retrospective analysis of clinical stage IIB/IIC melanoma patients who underwent SNB from 2000 to 2015 in a single institution. Prognostic factors related to distant recurrence-free survival (DRFS) and melanoma-specific survival (MSS) were assessed from multiple Cox regression. Relevant variables were used to create risk predictor nomograms for DRFS and MSS. Results. From 1213 SNB, 259 were performed for clinical stage IIB/IIC melanoma patients. SNB status was the most important variable for both endpoints. Patients with
Marcus Vitor Nunes Lindote, Marcus Rodrigo Monteiro and Eduardo Doria Filho have contributed equally to this work.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08959-9) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 3 June 2020 Accepted: 2 July 2020 E. Bertolli, MD, PhD e-mail: [email protected]
positive SNB presented median DRFS of 35.73 months (95% CI 21.38–50.08, SE 7.32) and median MSS of 66.4 months (95% CI 29.76–103.03, SE 18.69), meanwhile both median DRFS and MSS were not achieved for those with negative SNB (logrank \ 0.0001). Both nomograms have been internally validated and presented adequate calibration (C-index was 0.734 for DRFS and 0.718 for MSS). Conclusions. SNB status was the most important risk factor in our cohort of clinical stage IIB and IIC patients and, in conjunction with well-established primary tumor characteristics, should not be abandoned. Their use in prognosis for these patients remains extremely useful for daily practice.
Although sentinel node biopsy (SNB) has been considered the most important tool for nodal staging in melanoma patients during recent decades,1–5 its role has been reconsidered.6–9 On the one hand, SNB remains very usefu
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