Sentinel lymph node melanoma metastases: Assessment of tumor burden for clinical prediction of outcome in the first Multicenter Selective Lymphadenectomy Trial (MSLT-I)

Alistair J Cochran; Duan-Ren Wen; Rong-Rong Huang; Payam Abrishami; Chandra Smart; Scott Binder; Richard A Scolyer; John F Thompson; Stacey Stern; Lisa Van Kreuningen; David E Elashoff; Myung-Shin Sim; He-Jing Wang; Mark B Faries; MSLT-I Study Group

doi:10.1016/j.ejso.2022.01.021

Sentinel lymph node melanoma metastases: Assessment of tumor burden for clinical prediction of outcome in the first Multicenter Selective Lymphadenectomy Trial (MSLT-I)

Eur J Surg Oncol. 2022 Jun;48(6):1280-1287. doi: 10.1016/j.ejso.2022.01.021. Epub 2022 Feb 12.

Authors

Collaborators

MSLT-I Study Group:
John Kirkwood, John Daly, Michael Kutner, Martin Mihm, Gary Smith, Marshal Urist, Norman Beegun¹⁰

Affiliations

¹ Department of Pathology and Laboratory Medicine, University of California, Los Angeles, USA; Department of Surgery, University of California, Los Angeles, USA; John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA. Electronic address: [email protected].
² Department of Pathology and Laboratory Medicine, University of California, Los Angeles, USA.
³ Binder Institute of Pathology, Affiliated Pathologists Medical Group, Hermosa Beach, CA, USA.
⁴ Melanoma Institute Australia, Sydney, Australia; The University of Sydney, Sydney, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia.
⁵ Melanoma Institute Australia, Sydney, Australia; The University of Sydney, Sydney, Australia.
⁶ John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
⁷ Department of Biomathematics, University of California, Los Angeles, USA; John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
⁸ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁹ John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA; The Angeles Clinic and Research Institute, Los Angeles, USA; Cedars Sinai Medical Center, Los Angeles, CA, USA.
¹⁰ Esq, USA.

PMID: 35246348
DOI: 10.1016/j.ejso.2022.01.021

Abstract

Purpose: As clinical management decisions in patients with Stage III melanoma have become more complex, precise pathologic characterization of sentinel lymph node (SLN) metastases has become critical to guide management. The extent of SLN involvement correlates with risk of adverse outcomes, but reported methods of disease quantification vary. We examined SLN metastases from patients participating in an international clinical trial and compared several methods of tumor burden quantification.

Methods: SLNs from 146 node-positive patients in the first Multicenter Selective Lymphadenectomy Trial (MSLT-I) were centrally-reviewed and characterized by number of tumor-positive nodes, percent nodal area tumor replacement, maximum dimension of largest metastasis, tumor penetrative depth, number of tumor foci, metastasis microanatomic location, and extracapsular extension. These data were analyzed for correlation with non-SLN metastasis and melanoma-specific survival (MSS).

Results: The median number of tumor-involved SLNs was 1. The median maximum metastasis dimension was 1.11 mm. Median SLN area involvement was 1.5%. Tumor burden measures were highly correlated with each other. Factors associated with non-SLN metastasis by univariable analysis were primary tumor ulceration and extent of metastases. Tumor thickness, ulceration, non-SLN metastasis and multiple measures of SLN tumor burden were significantly related to MSS on univariable analysis. After multivariable adjustment, number of involved SLNs (p = 0.05) and percent nodal area tumor replacement (p = 0.02) were independent predictors of MSS.

Conclusion: Central review of MSLT-I pathology indicates that primary tumor and SLN tumor characteristics predict non-SLN metastasis and MSS. Percent nodal involvement was more powerfully prognostic than the more commonly used maximum dimension of largest metastasis.

Publication types

Multicenter Study

MeSH terms

Humans
Lymph Node Excision
Lymph Nodes / pathology
Lymph Nodes / surgery
Lymphadenopathy*
Lymphatic Metastasis / pathology
Melanoma* / pathology
Prognosis
Sentinel Lymph Node Biopsy
Sentinel Lymph Node* / pathology
Skin Neoplasms* / pathology
Skin Neoplasms* / surgery
Tumor Burden