Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram-Reference-Cited by-同舟云学术

Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram

Published:2020-05-10 Issue:14 Volume:38 Page:1591-1601
ISSN:0732-183X
Container-title:Journal of Clinical Oncology
language:en
Short-container-title:JCO

Author:

Maurichi Andrea¹,Miceli Rosalba²,Eriksson Hanna³⁴,Newton-Bishop Julia⁵,Nsengimana Jérémie⁵,Chan May⁵,Hayes Andrew J.⁶⁷,Heelan Kara⁶⁷,Adams David⁸,Patuzzo Roberto¹,Barretta Francesco²,Gallino Gianfranco¹,Harwood Catherine⁹,Bergamaschi Daniele⁹,Bennett Dorothy¹⁰,Lasithiotakis Konstantinos¹¹¹²,Ghiorzo Paola¹³,Dalmasso Bruna¹³,Manganoni Ausilia¹⁴,Consoli Francesca¹⁴,Mattavelli Ilaria¹,Barbieri Consuelo¹,Leva Andrea¹,Cortinovis Umberto¹⁵,Espeli Vittoria¹⁶,Mangas Cristina¹⁶,Quaglino Pietro¹⁷,Ribero Simone¹⁷,Broganelli Paolo¹⁷,Pellacani Giovanni¹⁸,Longo Caterina¹⁹²⁰,Del Forno Corrado²¹,Borgognoni Lorenzo²²,Sestini Serena²²,Pimpinelli Nicola²³,Fortunato Sara²³,Chiarugi Alessandra²⁴,Nardini Paolo²⁴,Morittu Elena²⁵,Florita Antonio²⁵,Cossa Mara¹²,Valeri Barbara¹²,Milione Massimo¹²,Pruneri Giancarlo¹²,Zoras Odysseas²⁶,Anichini Andrea²⁷,Mortarini Roberta²⁷,Santinami Mario¹

Affiliation:

1. Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy

2. Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

3. Department of Oncology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden

4. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

5. Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom

6. Sarcoma Unit, Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom

7. Skin Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom

8. Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Hinxton, United Kingdom

9. Queen Mary University of London, London, United Kingdom

10. Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom

11. York Teaching Hospital NHS Foundation Trust, York, United Kingdom

12. Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

13. University Hospital of Genoa, Genoa, Italy

14. University Hospital of Brescia, Brescia, Italy

15. Plastic and Reconstructive Surgical Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

16. Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland

17. University Hospital of Turin, Turin, Italy

18. University Hospital of Modena, Modena, Italy

19. Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy

20. Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy

21. University Hospital of Pavia, Pavia, Italy

22. Ospedale S. Maria Annunziata, Tuscan Cancer Institute, Florence, Italy

23. Division of Dermatology, University of Florence, Florence, Italy

24. Institute for Cancer Research and Prevention, Florence, Italy

25. Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

26. University Hospital of Heraklion, Heraklion, Greece

27. Immunobiology of Human Cancers Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

Abstract

PURPOSEThin melanomas (T1; ≤ 1 mm) constitute 70% of newly diagnosed cutaneous melanomas. Regional node metastasis determined by sentinel node biopsy (SNB) is an important prognostic factor for T1 melanoma. However, current melanoma guidelines do not provide clear indications on when to perform SNB in T1 disease and stress an individualized approach to SNB that considers all clinicopathologic risk factors. We aimed to identify determinants of sentinel node (SN) status for incorporation into an externally validated nomogram to better select patients with T1 disease for SNB.PATIENTS AND METHODSThe development cohort comprised 3,666 patients with T1 disease consecutively treated at the Istituto Nazionale Tumori (Milan, Italy) between 2001 and 2018; 4,227 patients with T1 disease treated at 13 other European centers over the same period formed the validation cohort. A random forest procedure was applied to the development data set to select characteristics associated with SN status for inclusion in a multiple binary logistic model from which a nomogram was elaborated. Decision curve analyses assessed the clinical utility of the nomogram.RESULTSOf patients in the development cohort, 1,635 underwent SNB; 108 patients (6.6%) were SN positive. By univariable analysis, age, growth phase, Breslow thickness, ulceration, mitotic rate, regression, and lymphovascular invasion were significantly associated with SN status. The random forest procedure selected 6 variables (not growth phase) for inclusion in the logistic model and nomogram. The nomogram proved well calibrated and had good discriminative ability in both cohorts. Decision curve analyses revealed the superior net benefit of the nomogram compared with each individual variable included in it as well as with variables suggested by current guidelines.CONCLUSIONWe propose the nomogram as a decision aid in all patients with T1 melanoma being considered for SNB.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

Link

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.19.01902

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