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Tejera-Vaquerizo A, Boada A, Ribero S, Puig S, Paradela S, Moreno-Ramírez D, Cañueto J, de Unamuno-Bustos B, Brinca A, Descalzo-Gallego MA, Osella-Abate S, Cassoni P, Podlipnik S, Carrera C, Vidal-Sicart S, Pigem R, Toll A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández-Orland A, Jaka A, Fernández-Figueras MT, Richarz NA, Vieira R, Botella-Estrada R, Román-Curto C, Ferrándiz-Pulido L, Iglesias-Pena N, Ferrándiz C, Malvehy J, Quaglino P, Nagore E. Sentinel Lymph Node Biopsy vs. Observation in Thin Melanoma: A Multicenter Propensity Score Matching Study. J Clin Med 2021; 10:jcm10245878. [PMID: 34945175 PMCID: PMC8708109 DOI: 10.3390/jcm10245878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
Abstract
The therapeutic value of sentinel lymph node biopsy (SLNB) in thin melanoma remains controversial. The aim of this study is to determine the role of SLNB in the survival of thin melanomas (≤1 mm). A multicenter retrospective observational study was designed. A propensity score matching was performed to compare patients who underwent SLNB vs. observation. A multivariate Cox regression was used. A total of 1438 patients were matched by propensity score. There were no significant differences in melanoma-specific survival (MSS) between the SLNB and observation groups. Predictors of MSS in the multivariate model were age, tumor thickness, ulceration, and interferon treatment. Results were similar for disease-free survival and overall survival. The 5- and 10-year MSS rates for SLN-negative and -positive patients were 98.5% vs. 77.3% (p < 0.001) and 97.3% vs. 68.7% (p < 0.001), respectively. SLNB does not improve MSS in patients with thin melanoma. It also had no impact on DSF or OS. However, a considerable difference in MSS, DFS, and OS between SLN-positive and -negative patients exists, confirming its value as a prognostic procedure and therefore we recommend discussing the option of SLNB with patients.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- Dermatology Department, Instituto Dermatológico GlobalDerm, 14700 Palma del Río, Spain
- Cutaneous Oncology Unit, Hospital San Juan de Dios, 14012 Córdoba, Spain
- Correspondence: ; Tel.: +34-957644564
| | - Aram Boada
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | - Simone Ribero
- Medical Sciences Department, Section of Dermatology, University of Turin, 10124 Turin, Italy; (S.R.); (P.Q.)
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Sabela Paradela
- Departamento de Dermatología, Hospital Universitario de la Coruña, 15006 La Coruña, Spain; (S.P.); (N.I.-P.)
| | - David Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (D.M.-R.); (A.F.-O.); (L.F.-P.)
| | - Javier Cañueto
- Dermatology Department, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain; (J.C.); (C.R.-C.)
| | - Blanca de Unamuno-Bustos
- Dermatology Department, Hospital Universitario La Fe, 46126 Valencia, Spain; (B.d.U.-B.); (R.B.-E.)
| | - Ana Brinca
- Departament of Dermatology, University Hospital of Coimbra, 3000-075 Coimbra, Portugal; (A.B.); (R.V.)
| | | | - Simona Osella-Abate
- Medical Sciences Department, Section of Surgical Pathology, University of Turin, 10124 Turin, Italy; (S.O.-A.); (P.C.)
| | - Paola Cassoni
- Medical Sciences Department, Section of Surgical Pathology, University of Turin, 10124 Turin, Italy; (S.O.-A.); (P.C.)
| | - Sebastian Podlipnik
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
| | - Ramón Pigem
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Agustí Toll
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Ramón Rull
- Surgery Department, Hospital Clinic, Universidad de Barcelona, 08036 Barcelona, Spain;
| | - Llucìa Alos
- Pathology Department, Hospital Clinic, Universidad de Barcelona, 08036 Barcelona, Spain;
| | - Celia Requena
- Dermatology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain; (C.R.); (E.N.)
| | - Isidro Bolumar
- Surgery Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Víctor Traves
- Pathology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Ángel Pla
- Otorhinolaringology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Almudena Fernández-Orland
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (D.M.-R.); (A.F.-O.); (L.F.-P.)
| | - Ane Jaka
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | | | - Nina Anika Richarz
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | - Ricardo Vieira
- Departament of Dermatology, University Hospital of Coimbra, 3000-075 Coimbra, Portugal; (A.B.); (R.V.)
| | - Rafael Botella-Estrada
- Dermatology Department, Hospital Universitario La Fe, 46126 Valencia, Spain; (B.d.U.-B.); (R.B.-E.)
| | - Concepción Román-Curto
- Dermatology Department, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain; (J.C.); (C.R.-C.)
- Instituto de Investigación Biomédica de Salamanca, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain
| | - Lara Ferrándiz-Pulido
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (D.M.-R.); (A.F.-O.); (L.F.-P.)
| | - Nicolás Iglesias-Pena
- Departamento de Dermatología, Hospital Universitario de la Coruña, 15006 La Coruña, Spain; (S.P.); (N.I.-P.)
| | - Carlos Ferrándiz
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Pietro Quaglino
- Medical Sciences Department, Section of Dermatology, University of Turin, 10124 Turin, Italy; (S.R.); (P.Q.)
| | - Eduardo Nagore
- Dermatology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain; (C.R.); (E.N.)
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Tejera‐Vaquerizo A, Ribero S, Puig S, Boada A, Paradela S, Moreno‐Ramírez D, Cañueto J, de Unamuno B, Brinca A, Descalzo‐Gallego MA, Osella‐Abate S, Cassoni P, Carrera C, Vidal‐Sicart S, Bennássar A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández‐Orland A, Jaka A, Fernández‐Figueres MT, Hilari JM, Giménez‐Xavier P, Vieira R, Botella‐Estrada R, Román‐Curto C, Ferrándiz L, Iglesias‐Pena N, Ferrándiz C, Malvehy J, Quaglino P, Nagore E. Survival analysis and sentinel lymph node status in thin cutaneous melanoma: A multicenter observational study. Cancer Med 2019; 8:4235-4244. [PMID: 31215168 PMCID: PMC6675713 DOI: 10.1002/cam4.2358] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 12/27/2022] Open
Abstract
Mitotic rate is no longer considered a staging criterion for thin melanoma in the 8th edition of the American Joint Committee on Cancer Staging Manual. The aim of this observational study was to identify prognostic factors for thin melanoma and predictors and prognostic significance of sentinel lymph node (SLN) involvement in a large multicenter cohort of patients with melanoma from nine tertiary care hospitals. A total of 4249 consecutive patients with thin melanoma diagnosed from January 1, 1998 to December 31, 2016 were included. The main outcomes were disease-free interval and melanoma-specific survival for the overall population and predictors of SLN metastasis (n = 1083). Associations between survival and SLN status and different clinical and pathologic variables (sex, age, tumor location, mitosis, ulceration, regression, lymphovascular invasion, histologic subtype, Clark level, and Breslow thickness) were analyzed by Cox proportional hazards regression and logistic regression. SLN status was the most important prognostic factor for melanoma-specific survival (hazard ratio, 13.8; 95% CI, 6.1-31.2; P < 0.001), followed by sex, ulceration, and Clark level for patients who underwent SLNB. A mitotic rate of >2 mitoses/mm2 was the only factor associated with a positive SLN biopsy (odds ratio, 2.9; 95% CI, 1.22-7; P = 0.01. SLN status is the most important prognostic factor in thin melanoma. A high mitotic rate is associated with metastatic SLN involvement. SLN biopsy should be discussed and recommended in patients with thin melanoma and a high mitotic rate.
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Affiliation(s)
| | - Simone Ribero
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Aram Boada
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Sabela Paradela
- Departamento de DermatologíaHospital Universitario de la CoruñaLa CoruñaSpain
| | - David Moreno‐Ramírez
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Javier Cañueto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Blanca de Unamuno
- Departamento de DermatologíaHospital Universitario La FeValenciaSpain
| | - Ana Brinca
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Simona Osella‐Abate
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Paola Cassoni
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Sergi Vidal‐Sicart
- Nuclear Medicine DepartmentHospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Antoni Bennássar
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Ramón Rull
- Surgery DepartmentHospital ClinicBarcelonaSpain
| | - Llucìa Alos
- Pathology Department, Hospital ClinicUniversidad de BarcelonaBarcelonaSpain
| | - Celia Requena
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Isidro Bolumar
- Surgery DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Víctor Traves
- Pathology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Ángel Pla
- Otorhinolaringology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - A. Fernández‐Orland
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Ane Jaka
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | | | - Josep M. Hilari
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Pol Giménez‐Xavier
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Ricardo Vieira
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Concepción Román‐Curto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Lara Ferrándiz
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | | | - Carlos Ferrándiz
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Pietro Quaglino
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Eduardo Nagore
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
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Tejera-Vaquerizo A, Descalzo-Gallego MA, Traves V, Requena C, Bolumar I, Pla A, Nagore E. No association between smoking and sentinel lymph node metastasis and survival in cutaneous melanoma. J Eur Acad Dermatol Venereol 2019; 33:2283-2290. [PMID: 31283036 DOI: 10.1111/jdv.15789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/21/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is little evidence that smoking is associated with metastasis in patients with cutaneous melanoma. OBJECTIVE Using a propensity score matching analysis, we assessed whether smoking was associated with a higher rate of sentinel lymph node (SLN) metastasis and worse survival in these patients. METHODS Retrospective cohort study at a referral hospital for melanoma. We studied 762 patients with known smoking status from the melanoma database of the Instituto Valenciano de Oncología who underwent SLN biopsy between 1 January 2000 and 31 December 2016. The patients were matched by smoking status. The matching procedure was implemented using three logistic regression models featuring never vs. former smokers, never vs. current smokers and former vs. current smokers. The study outcomes were disease-free survival (DFS), melanoma-specific survival (MSS), overall survival (OS) and SLN status. RESULTS The following groups were formed based on the propensity matching scores: 114 pairs of smokers vs. never smokers, 113 pairs of smokers vs. former smokers and 174 pairs of never smokers vs. former smokers. Smoking status was not associated with SLN metastasis or with DFS, MSS or OS in any of the three groups. CONCLUSION Smoking does not influence SLN metastasis or survival in patients with cutaneous melanoma.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río (Córdoba), Spain
| | | | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - I Bolumar
- Servicio de Cirugía, Instituto Valencia de Oncología, Valencia, Spain
| | - A Pla
- Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, Spain
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
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Olmedo D, Brotons-Seguí M, del Toro C, González M, Requena C, Traves V, Pla A, Bolumar I, Moreno-Ramírez D, Nagore E. Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis. Actas Dermo-Sifiliográficas (English Edition) 2017. [DOI: 10.1016/j.adengl.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Boada A, Tejera-Vaquerizo A, Ribero S, Puig S, Moreno-Ramírez D, Descalzo-Gallego MA, Fierro MT, Quaglino P, Carrera C, Malvehy J, Vidal-Sicart S, Bennássar A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández-Figueras MT, Ferrándiz C, Pascual I, Manzano JL, Sánchez-Lucas M, Giménez-Xavier P, Ferrandiz L, Nagore E. Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study. Int J Cancer 2017; 142:641-648. [DOI: 10.1002/ijc.31078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Aram Boada
- Dermatology Department; Hospital Universitari Germans Trial i Pujol, Badalona, Universitat Autònoma de Barcelona; Spain
| | | | - Simone Ribero
- Medical Sciences Department, Section of Dermatology; University of Turin; Italy
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - David Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department; Hospital Universitario Virgen Macarena; Sevilla Spain
| | | | - María T. Fierro
- Medical Sciences Department, Section of Dermatology; University of Turin; Italy
| | - Pietro Quaglino
- Medical Sciences Department, Section of Dermatology; University of Turin; Italy
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Antoni Bennássar
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Ramón Rull
- Surgery Department; Hospital Clinic; Barcelona Spain
| | - Llucìa Alos
- Pathology Department, Hospital Clinic; Universidad de Barcelona; Barcelona Spain
| | - Celia Requena
- Dermatology Department; Instituto Valenciano de Oncología; Valencia Spain
| | - Isidro Bolumar
- Surgery Department; Instituto Valenciano de Oncología; Valencia Spain
| | - Víctor Traves
- Pathology Department; Instituto Valenciano de Oncología; Valencia Spain
| | - Ángel Pla
- Otorhinolaringology Department; Instituto Valenciano de Oncología; Valencia Spain
| | | | - Carlos Ferrándiz
- Dermatology Department; Hospital Universitari Germans Trial i Pujol, Badalona, Universitat Autònoma de Barcelona; Spain
| | - Iciar Pascual
- Surgery Department; Hospital Universitari Germans Trial i Pujol; Badalona Spain
| | - José L. Manzano
- Medical Oncology Department; Institut Català d'Oncologia, Hospital Universitari Germans Trial i Pujol; Badalona Spain
| | - Marina Sánchez-Lucas
- Grupo de Investigación, Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica, Hospital Universitario Virgen Macarena; Sevilla Spain
| | - Pol Giménez-Xavier
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - Lara Ferrandiz
- Melanoma Unit, Medical-&-Surgical Dermatology Department; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - Eduardo Nagore
- Dermatology Department; Instituto Valenciano de Oncología; Valencia Spain
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Tejera-Vaquerizo A, Descalzo-Gallego MA, Traves V, Requena C, Bolumar I, Pla A, Nagore E. The intriguing effect of delay time to sentinel lymph node biopsy on survival: a propensity score matching study on a cohort of melanoma patients. Eur J Dermatol 2017; 27:487-495. [PMID: 28944755 DOI: 10.1684/ejd.2017.3065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
BACKGROUND Time between primary melanoma excision and sentinel lymph node biopsy (SLNB) has not been sufficiently studied as an independent predictor of survival in cutaneous melanoma. OBJECTIVES We used propensity score matching to evaluate whether early SLNB (performed ≤40 days from excisional biopsy) is associated with higher mortality in patients with cutaneous melanoma. MATERIALS & METHODS A retrospective cohort study at a tertiary melanoma referral centre. We included 787 consecutive patients from the melanoma database of the Instituto Valenciano de Oncología who underwent a SLNB between 1st January 2000 and 31st December 2015, of whom 350 were matched into pairs using propensity score matching. The variable of interest was the time between primary melanoma excision and SLNB (≤40 days vs >40 days). The study outcomes were disease-free survival (DFS), melanoma-specific survival (MSS), and overall survival (OS). RESULTS A delay time of 40 days or less was associated with worse DSF (adjusted hazard ratio [AHR]: 1.68; 95% confidence interval [CI]: 1.07-2.65; p = 0.024), MSS (AHR: 2.06; 95% CI: 1.1-3.53; p = 0.08), and OS (AHR: 1.77; 95% CI: 1.11-2.83; p = 0.017). Other variables associated with shorter MSS were age, tumour location and thickness, mitotic rate, and SLN status. CONCLUSION Early SLNB was associated with worse survival in patients with cutaneous melanoma after adjusting for classic prognostic factors. A delay time of over 40 days was not associated with higher mortality.
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Affiliation(s)
| | | | - Victor Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, Spain
| | - Celia Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - Isidro Bolumar
- Servicio de Cirugía, Instituto Valencia de Oncología, Valencia, Spain
| | - Angel Pla
- Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valenciano, Spain
| | - Eduardo Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
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Olmedo D, Brotons-Seguí M, Del Toro C, González M, Requena C, Traves V, Pla A, Bolumar I, Moreno-Ramírez D, Nagore E. Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis. Actas Dermosifiliogr 2017; 108:931-938. [PMID: 28801012 DOI: 10.1016/j.ad.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/26/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB. MATERIALS AND METHODS We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy. RESULTS Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00). CONCLUSIONS Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients.
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Affiliation(s)
- D Olmedo
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Brotons-Seguí
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - C Del Toro
- Servicio de Radiodiagnóstico, Instituto Valenciano de Oncología, Valencia, España
| | - M González
- Servicio de Radiodiagnóstico, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - A Pla
- Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, España
| | - I Bolumar
- Servicio de Cirugía, Instituto Valenciano de Oncología, Valencia, España
| | - D Moreno-Ramírez
- Unidad de Gestión Clínica de Dermatología MQ, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
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Tejera-Vaquerizo A, Nagore E, Puig S, Robert C, Saiag P, Martín-Cuevas P, Gallego E, Herrera-Acosta E, Aguilera J, Malvehy J, Carrera C, Cavalcanti A, Rull R, Vilalta-Solsona A, Lannoy E, Boutros C, Benannoune N, Tomasic G, Aegerte P, Vidal-Sicart S, Palou J, Alos LL, Requena C, Traves V, Pla Á, Bolumar I, Soriano V, Guillén C, Herrera-Ceballos E. Effect of time to sentinel-node biopsy on the prognosis of cutaneous melanoma. Eur J Cancer 2015; 51:1780-93. [PMID: 26072362 DOI: 10.1016/j.ejca.2015.05.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/26/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In patients with primary cutaneous melanoma, there is generally a delay between excisional biopsy of the primary tumour and sentinel-node biopsy. The objective of this study is to analyse the prognostic implications of this delay. PATIENTS AND METHOD This was an observational, retrospective, cohort study in four tertiary referral hospitals. A total of 1963 patients were included. The factor of interest was the interval between the date of the excisional biopsy of the primary melanoma and the date of the sentinel-node biopsy (delay time) in the prognosis. The primary outcome was melanoma-specific survival and disease-free survival. RESULTS A delay time of 40 days or less (hazard ratio (HR), 1.7; confidence interval (CI), 1.2-2.5) increased Breslow thickness (Breslow ⩾ 2 mm, HR, > 3.7; CI, 1.4-10.7), ulceration (HR, 1.6; CI, 1.1-2.3), sentinel-node metastasis (HR, 2.9; CI, 1.9-4.2), and primary melanoma localised in the head or neck were independently associated with worse melanoma-specific survival (all P < 0.03). The stratified analysis showed that the effect of delay time was at the expense of the patients with a negative sentinel-node biopsy and without regression. CONCLUSION Early sentinel-node biopsy is associated with worse survival in patients with cutaneous melanoma.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Susana Puig
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Caroline Robert
- Department of Dermatology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Philippe Saiag
- Service de dermatologie générale et oncologique, Hôpital Ambroise-Paré, Université de Versailles, Boulogne cedex, France.
| | - Paula Martín-Cuevas
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Elena Gallego
- Servicio de Anatomía Patológica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Enrique Herrera-Acosta
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - José Aguilera
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Josep Malvehy
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Cristina Carrera
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Andrea Cavalcanti
- Department of Surgery, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Ramón Rull
- Departamento de Cirugía, Hospital Clínic, Universidad de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Antonio Vilalta-Solsona
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Emilie Lannoy
- Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Celine Boutros
- Department of Dermatology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Naima Benannoune
- Department of Dermatology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Gorana Tomasic
- Department of Pathology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Philippe Aegerte
- Service de Biostatistique et Informatique Médicale, Hôpital Ambroise-Paré, Boulogne, France.
| | - Sergi Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Josep Palou
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - L Lúcia Alos
- Departamento de Anatomía Patológica, Universidad de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Víctor Traves
- Departamento de Anatomía Patológica, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Ángel Pla
- Departamento de Otorrinolaringología, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Isidro Bolumar
- Departamento de Cirugía, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Virtudes Soriano
- Departamento de Oncología Médica, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Carlos Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Enrique Herrera-Ceballos
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
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Giménez M, Fliquete M, Fuster C, Vázquez Forner C, Llopis F, Arnal J, Bolumar I, Botella R, Guillem C, Almenar S, Vázquez Albaladejo C. Linfadenectomía selectiva (ganglio centinela) en el melanoma. Experiencia con 55 casos. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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