Predicting sentinel lymph node status in stage I/II melanoma

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Abstract
7501 Background: The histologic status of the sentinel lymph node (SLN) biopsy is one of the most important prognostic factors for recurrence and survival for patients with clinical stage I and II melanoma. SLN biopsy has modest morbidity, is costly, and is negative in the majority of patients. To address the issue of selecting patients at high and low risk for SLN metastasis, we sought prognostic factors that predict SLN involvement by examining characteristics of both the primary tumor and patient. Methods: Our study included a retrospective cohort of 327 patients with primary melanomas greater than 1.0 mm with no clinical evidence of metastatic disease, those commonly offered SLN biopsy, who underwent SLN biopsy between 1995 and June 2003. Logistic regression analyses were used to investigate the association between SLN positivity and Breslow thickness, Clark level, tumor infiltrating lymphocytes (TIL), ulceration, mitotic rate (MR), lesion site, gender, and age. Results: 51 of the 327 patients had at least one positive SLN (15.6%). Only MR, TIL and thickness were found to be independent prognostic factors for SLN positivity. For MR >3, the adjusted odds ratio (OR) was 3.1 (95% Confidence Interval (CI): 1.4–6.7) for absent TIL, the OR was 3.3 (CI: 1.7–6.5) and for thickness >2.0 mm, the OR was 2.6 (CI: 1.2–5.3). The proportion of patients with a positive SLN ranged from 3.8% in those with no risk factor (absent TIL, MR >3, and thickness >2.0 mm) to 48.3% for those with all 3 (see table). Conclusion: By incorporating TIL, MR and thickness into a prognostic model, both patients at high risk and minimal risk for SLN metastasis can be identified. When validated, this model can be used in patient management and trial design to select patients to have and be spared SLN biopsy. No significant financial relationships to disclose.

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