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Predicting Regional Lymph Node Recurrence in the Modern Age of Tumor-Positive Sentinel Node Melanoma: The Role of the First Postoperative Ultrasound

  • Melanoma
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A Correction to this article was published on 17 February 2023

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Abstract

Background

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II) led to a change in the management of tumor-positive sentinel lymph nodes (SLNs) from completion node dissection (CLND) to nodal observation. This study aimed to evaluate prognostic factors for predicting sentinel node basin recurrence (SNBR) using data from MSLT-II trial participants.

Methods

In MSLT-II, 1076 patients were treated with observation. Patients were included in the current study if they had undergone a post-sentinel node basin ultrasound (PSNB-US) within 4 months after surgery. The study excluded patients with positive SLN by reverse transcription-polymerase chain reaction (RT-PCR) or incomplete SLN pathologic data. Primary tumor, patient, PSNB-US, and SLN characteristics were evaluated. Multivariable regression analyses were performed to determine independent prognostic factors associated with SNBR.

Results

The study enrolled 737 patients: 193 (26.2%) patients with SNBR and 73 (9.9%) patients with first abnormal US. The patients with an abnormal first US were more likely to experience SNBR (23.8 vs. 5.0%). In the multivariable analyses, increased risk of SNBR was associated with male gender (adjusted hazard ratio [aHR], 1.38; 95% confidence interval [CI], 1.00–1.9; p = 0.049), increasing Breslow thickness (aHR, 1.10; 95% CI, 1.01–1.2; p = 0.038), presence of ulceration (aHR, 1.93; 95% CI, 1.42–2.6; p < 0.001), sentinel node tumor burden greater than 1 mm (aHR, 1.91; 95% CI, 1.10–3.3; p = 0.022), lymphovascular invasion (aHR, 1.53; 95% CI, 1.00–2.3; p = 0.048), and presence of abnormal PSNB-US (aHR, 4.29; 95% CI, 3.02–6.1; p < 0.001).

Conclusions

The first postoperative US together with clinical and pathologic factors may play an important role in predicting SNBR.

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Acknowledgement

This study was supported by NIH grants CA189163 and CA29605, the Borstein Family Foundation, the Donald L. Morton Research Fund, and the Melamad Family Foundation. The authors would like to acknowledge the following people and institutions on their contributions that lead to the publication of the MSLT-2 trial: John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica (M.B.F., D.S.B.H.), and the Departments of Pathology (A.J.C.), Biomathematics (H.-J.W., D.A.E., R.M.E.), and Medicine (D.A.E.), University of California, Los Angeles — both in California; Melanoma Institute Australia and the University of Sydney, Sydney (J.F.T., O.E.N.), Peter MacCallum Cancer Centre, Melbourne, VIC (M.H.), Princess Alexandra Hospital, Brisbane, QLD (B.M.S.), and Newcastle Melanoma Unit, Waratah, NSW (P.H.) — all in Australia; Huntsman Cancer Institute, Salt Lake City (R.H.A., R.D.N.), and Intermountain Healthcare Cancer Services–Intermountain Medical Center, Murray (T.L.B.) — both in Utah; Istituto Nazionale dei Tumori Napoli, Naples (N.M.), Istituto Europeo di Oncologia, Milan (A.T.), and Istituto Oncologico Veneto–University of Padua, Padua (C.R.R.) — all in Italy; H. Lee Moffitt Cancer Center, Tampa, FL (J.S.Z.); Helsinki University Hospital, Helsinki (T.J.); Dallas Surgical Group, Dallas (P.D.B.); Universitair Medisch Centrum Groningen, Groningen (H.J.H.), and Netherlands Cancer Institute, Amsterdam (M.W.J.M.W.) — both in the Netherlands; Norfolk and Norwich University Hospital, Norwich (M. Moncrieff), and Guy’s and St. Thomas’ NHS Foundation Trust, London (A.M.-R.) — both in the United Kingdom; Swedish Melanoma Study Group–University Hospital Lund, Lund, Sweden (C.I.); University of Michigan, Ann Arbor (M.S.S.); Wake Forest University, Winston-Salem (E.A.L.), and Duke University, Durham (R.S.) — both in North Carolina; Ohio State University, Columbus (D.A.); University of Zurich, Zurich (R.D.), and Centre Hospitalier Universitaire Vaudois, Lausanne (M. Matter) — both in Switzerland; Penn State Hershey Cancer Institute, Hershey (R.I.N.), Thomas Jefferson University (A.C.B.) and Fox Chase Cancer Center (J.M.F.), Philadelphia, and St. Luke’s University Health Network, Bethlehem (D.C.D.) — all in Pennsylvania; Greenville Health System Cancer Center, Greenville, SC (S.D.T.); Sunnybrook Research Institute, Toronto (F.W.), and Tom Baker Cancer Centre, Calgary, AB (G.M.) — both in Canada; University of Washington, Seattle (D.R.B.); Saint Louis University, St. Louis (E.H.); Vanderbilt University (D.B.J., M.C.K.), Nashville, and University of Tennessee, Knoxville (J.M.L.) — both in Tennessee; University Hospital Schleswig–Holstein– Campus Lübeck, Lübeck (P.T.), University Hospital of Würzburg, Würzburg (A.G.), and City Hospital of Nürnberg, Nuremberg (E.S.) — all in Germany; SUNY at Stony Brook Hospital Medical Center, Stony Brook (T.L.H.), Memorial Sloan Kettering Cancer Center, New York (C.E.A.), and Roswell Park Cancer Institute, Buffalo (J.M.K.)— all in New York; Northwestern University Feinberg School of Medicine (J.D.W.) and Rush University Medical Center (S.D.B.), Chicago; University of Wisconsin, Madison (H.B.N.); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (S.S.); M.D. Anderson Medical Center, Houston (J.E.G.); Johns Hopkins University School of Medicine, Baltimore (L.J.); University of Louisville, Louisville, KY (K.M.M.); Dartmouth–Hitchcock Medical Center, Lebanon, NH (R.J.B.); Hospital Clinic Barcelona, Barcelona (S.V.-S.); and Sentara CarePlex Hospital, Hampton, VA (R.A.H.) [citation #2].

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Authors and Affiliations

  1. Providence Saint John’s Cancer Institute, Santa Monica, CA, USA

    Jennifer Keller MD, Stacey Stern PhD, Rebecca Marcus MD, Jessica Weiss MD, Sean Nassoiy DO, Wade Christopher MD, Trevan Fischer MD & Richard Essner MD, FACS

  2. Providence Health and Services, Beaverton, OR, USA

    Shu-Ching Chang PhD

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  1. Jennifer Keller MD
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Correspondence to Richard Essner MD, FACS.

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Disclosure

Richard Essner, MD, is on the scientific advisory board and speaker’s bureau for Castle Biosciences and is an advisor for Intra Medical Imaging, Los Angeles, CA, USA. The remaining authors have no conflicts of interest.

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Keller, J., Stern, S., Chang, SC. et al. Predicting Regional Lymph Node Recurrence in the Modern Age of Tumor-Positive Sentinel Node Melanoma: The Role of the First Postoperative Ultrasound. Ann Surg Oncol 29, 8469–8477 (2022). https://doi.org/10.1245/s10434-022-12345-y

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