Survival in Patients With Sentinel Node–Positive Melanoma With Extranodal Extension

Authors:
Andrea Maurichi Melanoma and Sarcoma Surgical Unit,

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Francesco Barretta Clinical Epidemiology and Trial Organization Unit,

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Roberto Patuzzo Melanoma and Sarcoma Surgical Unit,

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Rosalba Miceli Clinical Epidemiology and Trial Organization Unit,

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Gianfranco Gallino Melanoma and Sarcoma Surgical Unit,

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Ilaria Mattavelli Melanoma and Sarcoma Surgical Unit,

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Consuelo Barbieri Melanoma and Sarcoma Surgical Unit,

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Andrea Leva Melanoma and Sarcoma Surgical Unit,

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Martina Angi Melanoma and Sarcoma Surgical Unit,

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Francesco Baldo Lanza Melanoma and Sarcoma Surgical Unit,

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Giuseppe Spadola Melanoma and Sarcoma Surgical Unit,

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Mara Cossa Department of Pathology,

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Francesco Nesa Department of Pathology,

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Umberto Cortinovis Plastic and Reconstructive Surgical Unit, and

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Laura Sala Plastic and Reconstructive Surgical Unit, and

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Lorenza Di Guardo Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

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Carolina Cimminiello Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

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Michele Del Vecchio Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

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Barbara Valeri Department of Pathology,

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Mario Santinami Melanoma and Sarcoma Surgical Unit,

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Volume/Issue:
Volume 19: Issue 10
Online Publication Date:
26 Jul 2021
DOI:
https://doi.org/10.6004/jnccn.2020.7693
Restricted access

Background: Prognostic parameters in sentinel node (SN)–positive melanoma are important indicators to identify patients at high risk of recurrence who should be candidates for adjuvant therapy. We aimed to evaluate the presence of melanoma cells beyond the SN capsule—extranodal extension (ENE)—as a prognostic factor in patients with positive SNs. Methods: Data from 1,047 patients with melanoma and positive SNs treated from 2001 to 2020 at the Istituto Nazionale dei Tumori in Milano, Italy, were retrospectively investigated. Kaplan-Meier survival and crude cumulative incidence of recurrence curves were estimated. A multivariable logistic model was used to investigate the association between ENE and selected predictive factors. Cox models estimated the effect of the selected predictors on survival endpoints. Results: Median follow-up was 69 months. The 5-year overall survival rate was 62.5% and 71.7% for patients with positive SNs with and without ENE, respectively. The 5-year disease-free survival rate was 54.0% and 64.0% for patients with positive SNs with and without ENE, respectively. The multivariable logistic model showed that age, size of the main metastatic focus in the SN, and numbers of metastatic non-SNs were associated with ENE (all P<.0001). The multivariable Cox regression models showed the estimated prognostic effects of ENE associated with age, ulceration, size of the main metastatic focus in the SN, and number of metastatic non-SNs (all P<.0001) on disease-free survival and overall survival. Conclusions: ENE was a significant prognostic factor in patients with positive-SN melanoma. This parameter may be useful in clinical practice as a selection criterion for adjuvant treatment in patients with stage IIIA disease with a tumor burden <1 mm in the SN. We recommend its inclusion as an independent prognostic determinant in future updates of melanoma guidelines.

Submitted July 9, 2020; final revision received November 5, 2020; accepted for publication November 30, 2020. Published online July 26, 2021.

Author contributions: Study concept: Maurichi, Barretta, Miceli, Santinami. Data acquisition: Patuzzo, Gallino, Mattavelli, Barbieri, Leva, Spadola, Cortinovis, Sala. Data analysis and interpretation: Maurichi, Cossa, Nesa, Cimminiello, Di Guardo, Valeri, Santinami. Statistical analysis: Barretta, Miceli. Manuscript preparation: Maurichi, Barretta, Miceli, Angi, Lanza, Del Vecchio. Manuscript review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Andrea Maurichi, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian 1, 20133 Milan, Italy. Email: andrea.maurichi@istitutotumori.mi.it

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Copyright:
Copyright © 2021 by the National Comprehensive Cancer Network 2021
Page Numbers:
9
Article Category:
Research Article
Received:
09 Jul 2020
Accepted:
30 Nov 2020
Print Publication Date:
01 Oct 2021
Online Publication Date:
26 Jul 2021
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