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El Sharouni MA, Stodell MD, Ahmed T, Suijkerbuijk KPM, Cust AE, Witkamp AJ, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, van Gils CH, Lo SN. Sentinel node biopsy in patients with melanoma improves the accuracy of staging when added to clinicopathological features of the primary tumor. Ann Oncol 2020; 32:375-383. [PMID: 33253862 DOI: 10.1016/j.annonc.2020.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has been claimed, without supporting evidence, that knowledge of sentinel node (SN) status does not provide more accurate prognostic information than basic clinicopathological features of a primary cutaneous melanoma. We sought to investigate this claim and to quantify any additional value of SN status in predicting survival outcome. PATIENTS AND METHODS Data for a Dutch population-based cohort of melanoma patients (n = 9272) and for a validation cohort from a large Australian melanoma treatment center (n = 5644) were analyzed. Patients were adults diagnosed between 2004 and 2014 with histologically-proven, primary invasive cutaneous melanoma who underwent SN biopsy. Multivariable Cox proportional hazards analyses were carried out in the Dutch cohort to assess recurrence-free survival (RFS), melanoma-specific survival (MSS) and overall survival (OS). The findings were validated using the Australian cohort. Discrimination (Harrell's C-statistic), net benefit using decision curve analysis and net reclassification index (NRI) were calculated. RESULTS The Dutch cohort showed an improved C-statistic from 0.74 to 0.78 for OS and from 0.74 to 0.76 for RFS when SN status was included in the model with Breslow thickness, sex, age, site, mitoses, ulceration, regression and melanoma subtype. In the Australian cohort, the C-statistic increased from 0.70 to 0.73 for OS, 0.70 to 0.74 for RFS and 0.72 to 0.76 for MSS. Decision curve analyses showed that the 3-year and 5-year risk of death or recurrence were more accurately classified with a model that included SN status. At 3 years, sensitivity increased by 12% for both OS and RFS in the development cohort, and by 10% and 6% for OS and RFS, respectively, in the validation cohort. CONCLUSIONS Knowledge of SN status significantly improved the predictive accuracy for RFS, MSS and OS when added to a comprehensive suite of established clinicopathological prognostic factors. However, clinicians and patients must consider the magnitude of the improvement when weighing up the advantages and disadvantages of SN biopsy for melanoma.
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Affiliation(s)
- M-A El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M D Stodell
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Plastic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Cancer Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - C H van Gils
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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