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Combined factors helped predict positive SLN risk in patients with T1 melanoma
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Clinical and histologic prognostic factors in combination might help identify subgroups of patients with T1 melanoma at higher risk for sentinel lymph node positivity, according to study results.
Researchers studied the clinical and histologic features of 484 patients (mean age, 52.2 years; 55% men) with T1 melanoma for their ability to predict a positive sentinel lymph node biopsy (SLNB). They assessed the impact these factors had on SLN positivity and examined SLN status as an overall survival predictor.
Positive SLNB findings were present in 34 patients. A higher risk for SLN positivity was predicted by four factors:
- low tumor-infiltrating lymphocyte (TIL) levels
- being aged 43 years or younger
- lower extremity or trunk tumors
- Breslow depth 0.8 mm or greater
Low TIL levels (P=.0015; OR=2.96) and decreasing age (P=.0058; OR=1.66) were independent predictors of SLN positivity, according to multivariate analysis.
“If zero to two of these factors were present, the rate of a positive SLNB result was 3%; this increased to 15% with three factors present and to 30% if all four factors were present (P<.002),” the researchers wrote.
There was significantly decreased survival in SLN-positive patients (P=.003), with the strongest survival predictor being SLN status (P=.009).
Since the data analysis included patients from 1994 to 2007, a recently defined T1b criterion of mitotic rate was not included for all patients, the researchers reported.
“SLN status has significant prognostic impact in patients with thin melanomas,” the researchers concluded. “These results highlight the importance of TILs within the primary melanoma as a predictor of SLN status.
“This analysis may help identify patient subgroups with higher risk of SLN metastasis in what is traditionally considered a patient population at low risk. If validated in independent cohorts, this model may help select patient cohorts with thin melanoma to undergo SLNB.”
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