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Gene expression profiling, SLNB improved prediction of metastasis risk in patients with melanoma
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A gene expression profile test improved identification of the metastasis risk in patients with melanoma who underwent sentinel lymph node biopsy, according to recently published study results.
“The outcomes for patients with cutaneous melanoma are highly variable and there are limitations to the conventional staging system for melanoma,” researcher Pedram Gerami, MD, told Healio.com/Dermatology. “For example, although the status of the sentinel lymph node biopsy [SLNB] is considered the strongest prognosticator, approximately two-thirds of cutaneous melanoma patients who ultimately die from their melanoma will have a negative sentinel lymph node biopsy result.”
Pedram Gerami
Gerami and colleagues evaluated data from a multicenter cohort of 217 patients with melanoma who had undergone an SLNB procedure. The researchers assessed the expression of 31 genes from primary melanoma tumors by performing reverse transcription polymerase chain reaction (RT-PCR). Clinical data were used to determine SLNB outcome. Kaplan-Meier and Cox regression analyses were used to determine prognostic accuracy of the tests.
When compared with SLNB, gene expression profile (GEP) displayed more significant results and was a better predictor of each primary end point, including disease-free survival (DFS), distant metastasis-free survival (DMFS) and overall survival, in univariate and multivariate regression analysis (P<.001 for all), according to the researchers.
Prognostication was improved when GEP was combined with SLNB, with individual overall 5-year DFS and DMFS 79% and 82% for class-1 patients and 55% and 64% for SLNB-negative patients. Kaplan-Meier analysis determined a 5-year, disease-free survival of 35%, distant metastasis-free survival of 49% and overall survival of 54% for patients with a GEP high-risk outcome and negative SNLB results.
“We showed, using a technique known as mRNA expression profiling to determine which genes are highly active and which are not, that a molecular prognostic assay with accuracy could be developed,” Gerami said. “This assay can accurately classify patients based on their gene signature as having a high or low risk for metastasis and death from their melanoma.”
According to Gerami, the combination of GEP testing and SLNB identified approximately 80% of patients who eventually developed distant metastasis, with a specificity similar to SLNB alone. – by Bruce Thiel
Disclosure: Gerami serves as consult and speaker for Castle Biosciences. Please see the study for a full list of all other researchers’ relative financial disclosures.
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