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Disseminated cancer cell density indicated risk for melanoma death
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Disseminated cancer cell density in the sentinel node predicted prognosis of patients with melanoma, according to study results.
Increased density was associated with higher mortality risk, but even low numbers predicted shorter survival, researchers wrote.
Researchers analyzed 1,834 sentinel nodes from 1,027 patients with ultrasound node-negative melanoma who underwent sentinel node biopsy between 2000 and 2008. After median follow-up of 49 months (range, 3-123), 138 patients (13.4%) had died of melanoma.
Overall, increased disseminated cancer cell density — the number of cells per million lymphocytes in the sentinel node — increased risk for death (HR=1.81; 95% CI, 1.61-2.01). Researchers calculated a 10-fold increased risk for each one-unit increase in cell density.
Researchers calculated a 1.63 HR (95% CI, 1.02-2.58) for increased risk for death among patients with disseminated cancer cell density ≤3 vs. disseminated cancer cell density of zero.
Multivariable analysis showed disseminated cancer cell density in the sentinel node was a stronger predictor for death than histopathology. Tumor thickness and ulceration (P<.001 for both) also predicted survival.
Using these data, researchers developed a model for survival prediction based on tumor thickness, ulceration and disseminated cancer cell density.
The model more accurately predicted survival than American Joint Committee on Cancer staging categories, the researchers wrote. When researchers applied the model to study participants, they determined the model correctly classified an additional 13% of patients as having high risk for progression compared with AJCC staging.
“We provide evidence that quantification of lymphatic cancer cell dissemination is feasible and can be combined with other quantitative and qualitative characteristics of the primary tumor for accurate individual outcome prediction, probably not only for melanoma but for other types of solid cancer,” the researchers wrote. “It will be important to validate the findings in an independent study before the assay and the prediction model are used clinically.”
Disclosure: The researchers report no relevant financial disclosures.
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