@article{562648b963054e6382678a4fe92c8183,
title = "Sentinel node biopsy in patients with melanoma improves the accuracy of staging when added to clinicopathological features of the primary tumor",
abstract = "BACKGROUND: It has been claimed, without supporting evidence, that knowledge of sentinel node (SN) status does not provide more accurate prognostic information than basic clinicopathological features of a primary cutaneous melanoma. We sought to investigate this claim and to quantify any additional value of SN status in predicting survival outcome.PATIENTS AND METHODS: Data for a Dutch population-based cohort of melanoma patients (n = 9272) and for a validation cohort from a large Australian melanoma treatment center (n = 5644) were analyzed. Patients were adults diagnosed between 2004 and 2014 with histologically-proven, primary invasive cutaneous melanoma who underwent SN biopsy. Multivariable Cox proportional hazards analyses were carried out in the Dutch cohort to assess recurrence-free survival (RFS), melanoma-specific survival (MSS) and overall survival (OS). The findings were validated using the Australian cohort. Discrimination (Harrell's C-statistic), net benefit using decision curve analysis and net reclassification index (NRI) were calculated.RESULTS: The Dutch cohort showed an improved C-statistic from 0.74 to 0.78 for OS and from 0.74 to 0.76 for RFS when SN status was included in the model with Breslow thickness, sex, age, site, mitoses, ulceration, regression and melanoma subtype. In the Australian cohort, the C-statistic increased from 0.70 to 0.73 for OS, 0.70 to 0.74 for RFS and 0.72 to 0.76 for MSS. Decision curve analyses showed that the 3-year and 5-year risk of death or recurrence were more accurately classified with a model that included SN status. At 3 years, sensitivity increased by 12% for both OS and RFS in the development cohort, and by 10% and 6% for OS and RFS, respectively, in the validation cohort.CONCLUSIONS: Knowledge of SN status significantly improved the predictive accuracy for RFS, MSS and OS when added to a comprehensive suite of established clinicopathological prognostic factors. However, clinicians and patients must consider the magnitude of the improvement when weighing up the advantages and disadvantages of SN biopsy for melanoma.",
keywords = "melanoma, prognosis, sentinel node, staging, survival",
author = "{El Sharouni}, {M A} and Stodell, {M D} and T Ahmed and Suijkerbuijk, {K P M} and Cust, {A E} and Witkamp, {A J} and V Sigurdsson and {van Diest}, {P J} and Scolyer, {R A} and Thompson, {J F} and {van Gils}, {C H} and Lo, {S N}",
note = "Funding Information: This work was supported by the European Association of Dermatology and Venereology [Research Fellowship to MAES, grant number 1141295], Australian National Health and Medical Research Council Program Grant [grant number APP1093017 to RAS and JFT], Australian National Health and Medical Research Council Practitioner Fellowship [to RAS; grant number 1141295 ], Australian National Health and Medical Research Council Career Development Fellowship [grant number 1147843 to AEC], Cancer Institute New South Wales and the National Health and Medical Research Council Centre of Research Excellence in Melanoma [grant number 1135285 ]. SNL is supported by Melanoma Institute Australia. The authors are grateful for support from colleagues at their respective institutions, and support from the Ainsworth Foundation is also gratefully acknowledged. Funding Information: We thank Rinus Voorham (PALGA ) and Hazel Burke (MIA) for their assistance with data extraction, and the team of The Netherlands Comprehensive Cancer Organization (IKNL) for providing survival data from The Netherlands Cancer Registry. This work was supported by the European Association of Dermatology and Venereology [Research Fellowship to MAES, grant number 1141295], Australian National Health and Medical Research Council Program Grant [grant number APP1093017 to RAS and JFT], Australian National Health and Medical Research Council Practitioner Fellowship [to RAS; grant number 1141295], Australian National Health and Medical Research Council Career Development Fellowship [grant number 1147843 to AEC], Cancer Institute New South Wales and the National Health and Medical Research Council Centre of Research Excellence in Melanoma [grant number 1135285]. SNL is supported by Melanoma Institute Australia. The authors are grateful for support from colleagues at their respective institutions, and support from the Ainsworth Foundation is also gratefully acknowledged. RAS has received fees for professional services from QBiotics Group Limited, Novartis, NeraCare, Amgen Inc. BMS, Myriad Genetics GmbH, GSK and MSD. JFT has received honoraria for advisory board participation from BMS, MSD, GSK and Provectus Inc. and travel support from GSK and Provectus Inc. KPMS has received honoraria for advisory board participation (paid to institution) from Novartis, MSD, BMS and Pierre Fabre, travel support from Roche and MSD and a research grant from Novartis. The other authors have declared no conflicts of interest. Publisher Copyright: {\textcopyright} 2020 European Society for Medical Oncology",
year = "2021",
month = mar,
doi = "10.1016/j.annonc.2020.11.015",
language = "English",
volume = "32",
pages = "375--383",
journal = "Annals of oncology : official journal of the European Society for Medical Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
number = "3",
}