Article

Positive Nonsentinel Node Status Predicts Mortality in Patients with Cutaneous Melanoma

Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Annals of Surgical Oncology (Impact Factor: 3.94). 11/2008; 16(1):186-90. DOI: 10.1245/s10434-008-0187-5
Source: PubMed

ABSTRACT While sentinel lymph node biopsy (SLN) is a highly accurate and well-tolerated procedure for patients with cutaneous melanoma, the role of the completion lymph node dissection (CLND) for patients with positive SLN biopsy remains unknown. This study aimed to look at the prognostic value of a positive nonsentinel lymph node (NSLN). A prospectively maintained database identified 222 patients with cutaneous melanoma and a positive SLN biopsy, without evidence of distant disease. All of these patients underwent CLND, and 37 patients (17%) had positive NSLN. With median follow-up of 33 months, patients with negative NSLN had median survival of 104 months, while patients with positive NSLN had median survival of 36 months (p < 0.001). There were no survivors in the patients with positive NSLN beyond 6 years. When patients with an equal number of positive nodes were analyzed, the presence of a positive NSLN was still associated with worse melanoma-specific survival (66 months for NSLN- versus 34 months for NSLN+, p = 0.04). While increasing age, tumor thickness, and male sex were associated with an increased risk of death on multivariate analysis, a positive NSLN was the most important predictor of survival (hazard ratio 2.5). We conclude that positive NSLN is an independent predictor of disease-specific survival in patients with cutaneous melanoma.

1 Follower
 · 
109 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of melanoma has increased in North America, Europe, Australia, and New Zealand in the past decade. Currently, the mainstay treatment for patients with primary cutaneous melanoma is surgery, as adjuvant systemic therapy has limited efficacy. The role of sentinel node biopsy has been debated since its introduction 20 years ago. A review of the role of this technique in the management of patients with stage I and II melanoma in terms of staging, prognosis, morbidity, therapeutic benefit, and enrollment in clinical trials appears to be timely.
    06/2012; 1(2). DOI:10.1007/s13671-012-0008-8
  • [Show abstract] [Hide abstract]
    ABSTRACT: Applications that require the use of softball-sized or smaller robots impose size and power constraints that prohibit the use of active sensors such as ladar or sonar for mapping and localization. The small size of such robots also makes passive stereo vision impractical due to the limited baseline. As a result, map building capabilities for such robots will need to be based on structure from motion using monocular sequences of images. This paper presents a novel algorithm for estimation of 2-D hallway structure and robot motion given a set of feature observations from multiple images. The 2-D structure from motion algorithm is posed in a way that is linear in Cartesian coordinates given a set of camera rotations. Given an observation of a feature from a camera position, for a specified rotation of the camera's coordinate system relative to the world there is a linear constraint that the camera's location and the feature's location should both lie along the line of sight between the camera and the feature. Starting with an initial set of camera orientations, the algorithm iteratively switches between refining the estimated camera and feature positions and refining the estimated camera rotations. The performance of the structure from motion algorithm is demonstrated by comparison of the algorithm results on a sequence of images to the manually measured true structure of a typical hallway.
    Intelligent Vehicles Symposium, 2003. Proceedings. IEEE; 07/2003
  • [Show abstract] [Hide abstract]
    ABSTRACT: Microscopic satellitosis in melanoma is uncommon. The role of regional basin staging/therapy in patients with this high-risk feature has not been well defined. Patients presenting from 1996 to 2005 with clinically localized melanoma containing microscopic satellitosis were identified from a prospective, single-institution database. Multiple factors were analyzed to determine their predictive value for recurrence. The management of the draining nodal basin was evaluated to determine its impact on recurrence and survival. Thirty-eight patients presented to our institution during this time period with clinically localized melanoma containing microscopic satellitosis. The 5-year overall and disease-free survivals in these patients were 34% and 18%, respectively. Sixty-eight percent had pathologically involved regional nodal metastases. With median follow-up of 21 months, 68% recurred, with a median time to recurrence of 9 months. Lymphovascular invasion (LVI) (p = 0.01), tumor regression (p = 0.04), and positive regional lymph nodes (p = 0.02) were associated with an increased risk of recurrence. Of the 31 patients who underwent sentinel lymph node (SLN) biopsy, 22 had metastasis in the SLN (71%). Fifteen of these patients underwent completion lymphadenectomy (CLND) and seven were observed. There was no difference in disease-free survival (DFS), disease-specific survival (DSS), or overall survival (OS) between these groups (p = 0.42). Pathological lymph node metastases were more prevalent (68%) than in any group previously defined. Regional nodal status predicted recurrence but not nodal recurrence. In SLN-positive patients, CLND did not improve DFS, DSS, or OS, although the number of patients was small. Further studies are needed to determine the utility of regional nodal staging/therapy in these high-risk patients.
    Annals of Surgical Oncology 03/2009; 16(5):1176-83. DOI:10.1245/s10434-009-0350-7 · 3.94 Impact Factor

Preview

Download
0 Downloads
Available from