Sentinel node biopsy in patients with melanoma improves the accuracy of staging when added to clinicopathological features of the primary tumor
Autor: | Serigne Lo, P. J. Van Diest, John F. Thompson, Karijn P M Suijkerbuijk, Anne E. Cust, M.D. Stodell, Vigfús Sigurdsson, Richard A. Scolyer, M A El Sharouni, C. H. van Gils, Arjen J. Witkamp, Tasnia Ahmed |
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Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
Oncology Adult medicine.medical_specialty Skin Neoplasms Breslow Thickness 03 medical and health sciences 0302 clinical medicine Internal medicine Biopsy medicine Humans Melanoma Neoplasm Staging Retrospective Studies medicine.diagnostic_test Proportional hazards model business.industry Sentinel Lymph Node Biopsy Australia Hematology Sentinel node medicine.disease Prognosis Primary tumor 030104 developmental biology 030220 oncology & carcinogenesis Cutaneous melanoma Cohort business |
Zdroj: | Annals of oncology : official journal of the European Society for Medical Oncology. 32(3) |
ISSN: | 1569-8041 |
Popis: | Background It has been claimed, without supporting evidence, that knowledge of sentinel node (SN) status does not provide more accurate prognostic information than basic clinicopathological features of a primary cutaneous melanoma. We sought to investigate this claim and to quantify any additional value of SN status in predicting survival outcome. Patients and methods Data for a Dutch population-based cohort of melanoma patients (n = 9272) and for a validation cohort from a large Australian melanoma treatment center (n = 5644) were analyzed. Patients were adults diagnosed between 2004 and 2014 with histologically-proven, primary invasive cutaneous melanoma who underwent SN biopsy. Multivariable Cox proportional hazards analyses were carried out in the Dutch cohort to assess recurrence-free survival (RFS), melanoma-specific survival (MSS) and overall survival (OS). The findings were validated using the Australian cohort. Discrimination (Harrell's C-statistic), net benefit using decision curve analysis and net reclassification index (NRI) were calculated. Results The Dutch cohort showed an improved C-statistic from 0.74 to 0.78 for OS and from 0.74 to 0.76 for RFS when SN status was included in the model with Breslow thickness, sex, age, site, mitoses, ulceration, regression and melanoma subtype. In the Australian cohort, the C-statistic increased from 0.70 to 0.73 for OS, 0.70 to 0.74 for RFS and 0.72 to 0.76 for MSS. Decision curve analyses showed that the 3-year and 5-year risk of death or recurrence were more accurately classified with a model that included SN status. At 3 years, sensitivity increased by 12% for both OS and RFS in the development cohort, and by 10% and 6% for OS and RFS, respectively, in the validation cohort. Conclusions Knowledge of SN status significantly improved the predictive accuracy for RFS, MSS and OS when added to a comprehensive suite of established clinicopathological prognostic factors. However, clinicians and patients must consider the magnitude of the improvement when weighing up the advantages and disadvantages of SN biopsy for melanoma. |
Databáze: | OpenAIRE |
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