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Is the non-sentinel lymph node compartment the next site for melanoma progression from the sentinel lymph node compartment in the regional nodal basin?

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Abstract

Melanoma patients with additional positive lymph nodes in the completion lymph node dissection (CLND) following a positive sentinel lymph node (SLN) biopsy would have a poorer prognosis than patients with no additional positive lymph nodes. We hypothesize that the progression of disease from the SLN to the non-SLN compartment is orderly and is associated with the worsening of the disease status. Thus, the SLN and non-SLN compartments are biologically different in that cancer cells, in general, arrive in the SLN compartment before spreading to the non-SLN compartment. To validate this concept, we used a large cohort of melanoma patients from our prospective SLN database in an academic tertiary medical center. Adult cutaneous melanoma patients (n = 291) undergoing CLND after a positive SLN biopsy from 1994 to 2009 were analyzed. Comparison of 5-year disease-free survival and 5-year overall survival between positive (n = 66) and negative (n = 225) CLND groups was made. The 5-year disease-free survival rates were 55% (95% CI 49–62%) for patients with no additional LN on CLND versus 14% (95% CI 8–26%) in patients with positive LN on CLND (p < 0.0001, log-rank test). The median disease-free survival time was 7.4 years with negative CLND (95% CI 4.4–15+ years) and 1.2 years with positive CLND (95% CI 1.0–1.8 years). The 5-year overall survival rates were 67% (95% CI 61–74%) for negative CLND versus 38% (95% CI 28–52%) for positive CLND (p < 0.0001, log-rank test). The median overall survival time was 12.1 years for negative CLND (95% CI 9.3–15+ years) and 2.5 years for positive CLND (95% CI 2.2–5.7 years). This study shows that CLND status is a significant prognostic factor for patients with positive SLNs undergoing CLND. Also, it suggests an orderly progression of metastasis from the SLN to the non-SLN compartment. Thus, the SLN in the regional nodal basin draining the primary melanoma may serve as an important gateway for metastasis to the non-SLN compartment and beyond to the systemic sites.

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Acknowledgements

Dr. Cleaver is supported by “E.A.Dickson Emeritus Professorship” and by a gift from the Tumori Foundation courtesy of Dr. Devron Char, CPMC.

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Author notes

  1. Andrei Rios-Cantu, Victor Melendez-Elizondo & Alejandra Gutierrez-Range

    Present address: Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

Authors and Affiliations

  1. Center for Melanoma Research & Treatment, California Pacific Medical Center, 2340 Clay Street, 2nd Floor, San Francisco, CA, 94115, USA

    Andrei Rios-Cantu, Victor Melendez-Elizondo, Alejandra Gutierrez-Range, Niloofar Fadaki, Suresh Thummala, Carla West-Coffee, Mohammed Kashani–Sabet & Stanley P. L. Leong

  2. Departments of Biomedical Data Science, Health Research and Policy, and Radiology, The Stanford Cancer Institute, Stanford University, Stanford, CA, USA

    Ying Lu & Michael Chen

  3. Department of Dermatology, University of California, San Francisco, CA, USA

    James Cleaver

  4. Consorcio de Universidades Mexicanas (CuMEX), Pachuca, Mexico

    Andrei Rios-Cantu, Victor Melendez-Elizondo & Alejandra Gutierrez-Range

  5. University of Nevada, Las Vegas, Las Vegas, NV, USA

    Michael Chen

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  1. Andrei Rios-Cantu
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Correspondence to Stanley P. L. Leong.

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Rios-Cantu, A., Lu, Y., Melendez-Elizondo, V. et al. Is the non-sentinel lymph node compartment the next site for melanoma progression from the sentinel lymph node compartment in the regional nodal basin?. Clin Exp Metastasis 34, 345–350 (2017). https://doi.org/10.1007/s10585-017-9854-x

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  • DOI: https://doi.org/10.1007/s10585-017-9854-x

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