Although well-established, sentinel node biopsy (SNB) for melanoma is not free from controversies and sometimes it can be questionable if SNB should be considered even for patients who meet the criteria for the procedure. Mathematical tools such as nomograms can be helpful and give more precise answers for both clinicians and patients. We present a nomogram for SNB positivity that has been internally validated.
Methods:
Retrospective analysis of patients who underwent SNB from 2000 to 2015 in a single institution. Single logistic regressions were used to identify variables that were associated to SNB positivity. All variables with a p value < 0.05 were included in the final model. Overall performance, calibration, and discriminatory power of the final multiple logistic regression model were all assessed. Internal validation of the multiple logistic regression model was performed via bootstrap analysis based on 1000 replications.
Results:
Site of primary lesion, Breslow thickness, mitotic rate, histologic regression, lymphatic invasion, and Clark level were statistically related to SNB positivity. After internal validation, a good performance was observed as well as an adequate power of discrimination (area under the curve 0.751).
Conclusions:
We have presented a nomogram that can be helpful and easily used in daily practice for assessing SNB positivity.
MortonDLWenDRWongJH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg1992; 127: 392–399.
2.
MortonDLThompsonJFCochranAJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med2014; 370: 599–609.
3.
GershenwaldJEScolyerRAHessKR, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin2017; 67(6):472–492
4.
WongSLFariesMBKennedyEB, et al. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. J Clin Oncol2017; 19: JCO2017757724.
5.
National Comprehensive Cancer Network. Cutaneous melanoma. NCCN Clin Pract Guidelines Oncol2020; v3.2020.
6.
MaduMFWoutersMWJMvan AkkooiACJ. Sentinel node biopsy in melanoma: current controversies addressed. Eur J Surg Oncol2017; 43: 517–533.
7.
BigbyMZagarellaSSladdenM, et al. Time to reconsider the role of sentinel lymph node biopsy in melanoma. J Am Acad Dermatol2019; 80: 1168–1171.
8.
ZagarellaS.Sentinel lymph node biopsy still provides no benefits for patients with melanoma. Am J Dermatopathol2020; 42: 481–483.
9.
BevilacquaJLBKattanMWFeyJV, et al. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol2007; 25: 3670–3679.
10.
BalachandranVPGonenMSmithJJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol2015; 16: e173–e180.
11.
WongSLKattanMWMcMastersKM, et al. A nomogram that predicts the presence of sentinel node metastasis in melanoma with better discrimination than the American Joint Committee on Cancer staging system. Ann Surg Oncol2005; 12: 282–288.
12.
McMastersKMNoyesRDReintgenDS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol2004; 86: 212–223.
13.
PiñeroACanterasMOrtizE, et al. Validation of a nomogram to predict the presence of sentinel lymph node metastases in melanoma. Ann Surg Oncol2008; 15: 2874–2877.
14.
PasqualiSMocellinSCampanaLG, et al. Maximizing the clinical usefulness of a nomogram to select patients candidate to sentinel node biopsy for cutaneous melanoma. Eur J Surg Oncol2011; 37: 675–680.
15.
WoodsJFCDe MarchiJALoweryAJ, et al. Validation of a nomogram predicting sentinel lymph node status in melanoma in an Irish population. Irish J Med Sci2015; 184: 769–773.
16.
NaffoujeSANaffoujeRChenJ, et al. Validation and enhancement of the clinicopathological melanoma nomogram via incorporation of a molecular marker in the primary tumor. Anticancer Res2016; 36: 6603–6610.
17.
LoSNMaJScolyerRA, et al. Improved risk prediction calculator for sentinel node positivity in patients with melanoma: the Melanoma Institute Australia Nomogram. J Clin Oncol2020; 38: 2719–2727.
18.
BertolliEDe MacedoMPPintoCAL, et al. Evaluation of melanoma features and their relationship with nodal disease: the importance of the pathological report. Tumori2015; 101: 501–505.
19.
DupratJPSilvaDCPCoimbraFJF, et al. Sentinel lymph node biopsy in cutaneous melanoma: analysis of 240 consecutive cases. Plast Reconstr Surg2005; 115: 1944–1951; discussion 1952–1953.
20.
ScolyerRAJudgeMJEvansA, et al. data set for pathology reporting of cutaneous invasive melanoma. Am J Surg Pathol2013; 37: 1797–1814.
21.
SchoenfeldD.Partial residuals for the proportional hazards regression model. Biometrika1982; 69: 239–241.
22.
GrambschPMTherneauTM.Proportional hazards tests and diagnostics based on weighted residuals. Biometrika1994; 81: 515–526.
SteyerbergEWHarrellFE.Prediction models need appropriate internal, internal-external, and external validation. J Clin Epidemiol2016: 69: 245–247.
25.
HarrellFELeeKLMarkDB.Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med1996; 15: 361–387.
26.
Tejera-VaquerizoADescalzo-GallegoMATravesV, et al. 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 Dermatol2017; 27: 487–495.
27.
NelsonDWSternSElashoffDE, et al. Impact of time between diagnosis and SLNB on outcomes in cutaneous melanoma. J Am Coll Surg2017; 225: 302–131.
28.
CarpenterSPockajBDueckA, et al. Factors influencing time between biopsy and definitive surgery for malignant melanoma: do they impact clinical outcome?Am J Surg2008; 196: 834–843.
29.
Oude OphuisCMCvan AkkooiACJRutkowskiP, et al. Effects of time interval between primary melanoma excision and sentinel node biopsy on positivity rate and survival. Eur J Cancer2016; 67: 164–173.
30.
CrawfordABNessimCWeaverJ, et al. Wait times for melanoma surgery: is there an association with overall survival?Ann Surg Oncol2017; 25: 265–270.
31.
LeiterUStadlerRMauchC, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol2016; 17: 757–767.
32.
LeiterUStadlerRMauchC, et al. Final analysis of DeCOG-SLT trial: no survival benefit for complete lymph node dissection in patients with melanoma with positive sentinel node. J Clin Oncol2019; 37: 3000–3008.
33.
FariesMBThompsonJFCochranAJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med2017; 376: 2211–2222.
34.
VerverDvan KlaverenDvan AkkooiACJ, et al. Risk stratification of sentinel node–positive melanoma patients defines surgical management and adjuvant therapy treatment considerations. Eur J Cancer2018; 96: 25–33.
35.
UlmerADietzKWerner-KleinM, et al. The sentinel lymph node spread determines quantitatively melanoma seeding to non-sentinel lymph nodes and survival. Eur J Cancer2018; 91: 1–10.
36.
MaduMFFrankeVBruinMM, et al. Immediate completion lymph node dissection in stage IIIA melanoma does not provide significant additional staging information beyond EORTC SN tumour burden criteria. Eur J Cancer2017; 87: 212–215.
37.
IasonosASchragDRajGV, et al. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol2008; 26: 1364–1370.
38.
LiuRZZhaoZRNgCSH. Statistical modelling for thoracic surgery using a nomogram based on logistic regression. J Thorac Dis2016; 8: E731–E736.
39.
BertolliEFrankeVCalsavaraVF, et al. Validation of a nomogram for non-sentinel node positivity in melanoma patients, and its clinical implications: a Brazilian–Dutch study. Ann Surg Oncol2019; 26: 395–405.
40.
GualanoMROsella-AbateSScaioliG, et al. Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis. Br J Dermatol2017; 178: 357–362.
41.
FarbergASGlazerAMWinkelmannRR, et al. Assessing genetic expression profiles in melanoma prognosis. Dermatol Clin2017; 35: 545–550.
42.
GeramiPCookRWRussellMC, et al. Gene expression profiling for molecular staging of cutaneous melanoma in patients undergoing sentinel lymph node biopsy. J Am Acad Dermatol2015; 72: 780–785.
43.
FerrisLKFarbergASMiddlebrookB, et al. Identification of high-risk cutaneous melanoma tumors is improved when combining the online American Joint Committee on Cancer Individualized Melanoma Patient Outcome Prediction Tool with a 31-gene expression profile–based classification. J Am Acad Dermatol2017; 76: 818–825.
44.
HaoHXiaoDPanJ, et al. Sentinel lymph node genes to predict prognosis in node-positive melanoma patients. Ann Surg Oncol2017; 24: 108–116.
45.
BellomoDArias-MejiasSMRamanaC, et al. Model combining tumor molecular and clinicopathologic risk factors predicts sentinel lymph node metastasis in primary cutaneous melanoma. JCO Precis Oncol2020; 47: 319–334.
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